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High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: is targeted screening feasible?
J. Atashili1,2,3, A. Adimora3, P. Ndumbe1,2, G. Ikomey2, E. Myers3, J. Eron3, J. Smith3, W. Miller3
1University of Buea, Faculty of Health Sciences, Buea, Cameroon, 2University of Yaounde I, Center for the Study and Control of Communicable Diseases, Yaounde, Yaounde, Cameroon, 3UNC - Chapel Hill, Chapel Hill, United States
Background: Cervical cancer is the most common cancer in women in low-income countries. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women. We explored the potential for targeted screening by assessing the prevalence, severity and predictors of cervical squamous intra-epithelial lesions (SILs) in HIV-positive women in Cameroon.
Methods: We conducted a cross-sectional study of women on antiretroviral therapy between August and September of 2008 in three clinics in Cameroon. Socio-demographic, behavioral, and clinical information was obtained from eligible women by trained research assistants. Cervical exfoliated cells were then collected, a conventional cytology performed and epithelial lesions classified according to the Bethesda 2001 system.
Results: A total of 282 women, aged 19 to 68 years, were enrolled in this study. The median CD4 count was 179 cells/microliter (interquartile range: 100 to 271). SILs were detected in 43.5% of the 276 women with satisfactory samples: including atypical squamous cells of unknown significance (ASCUS) 0.7%, low-grade SIL (LSIL) 25.0%, atypical squamous cells, cannot exclude high grade lesions (ASC-H) 14.5%, and high-grade SIL (HSIL) 3.3%. None of the demographic or clinical characteristics considered significantly predicted the presence of any SILs or the presence of severe lesions requiring colposcopy. However, compared to women from urban areas, SILs appeared more frequent in women from rural areas (adjusted OR: 1.68; 95%CI: 0.88, 3.18). Severe lesions were somewhat more frequent in patients with CD4 counts below 200 (aOR: 1.49; 95%CI: 0.72, 3.07).
Conclusions: The prevalence of SIL in women on antiretroviral therapy in Cameroon was high, underscoring the need for screening and care in this population. In the absence of any accurate demographic or clinical predictor of SIL, targeted screening does not seem feasible. Alternative affordable screening options need to be explored.
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