title: Effect of Low CD4 Cell Count on Cervical Squamous Intraepithelial Lesions among HIV-Positive Women in Enugu, Southeastern Nigeria.
abstract: BACKGROUND
  HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions.
  
  
  METHODS
  Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/μl while the control group had CD4 cell count of ≥200 cells/μl.
  
  
  RESULTS
  The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703).
  
  
  CONCLUSIONS
  Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count.
authors.affiliation: Consultant, Department of Obstetrics and Gynaecology, Enugu State University of Technology Teaching Hospital , Parklane Enugu, Nigeria .
authors.forename: Joseph Tochukwu
authors.initials: JT
authors.lastname: Enebe
authors.affiliation: Senior Lecturer and Honorary Consultant, Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria , Enugu, Nigeria .
authors.forename: Cyril Chukwudi
authors.initials: CC
authors.lastname: Dim
authors.affiliation: Lecturer and Honorary Consultant, Department of Morbid Anatomy, College of Medicine, University of Nigeria , Enugu, Nigeria .
authors.forename: Emeka Francis
authors.initials: EF
authors.lastname: Nnakenyi
authors.affiliation: Professor and Honorary Consultant, Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria , Enugu, Nigeria .
authors.forename: Hyginus Uzochukwu
authors.initials: HU
authors.lastname: Ezegwui
authors.affiliation: Professor and Honorary Consultant, Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria , Enugu, Nigeria .
authors.forename: Benjamin Chukwuma
authors.initials: BC
authors.lastname: Ozumba
keywords: Cellular immunity; Cervical pre-malignant lesions; HIV sero-positivity