The Pattern Of Cervical Histology Among Women With Human Immunodeficiency Virus In Fection Receiving Care At A Terciary Centre In South-South Nigeria

International Journal of Research and Scientific Innovation (IJRSI) | Volume VIII, Issue IV, April 2021 | ISSN 2321–2705

The Pattern Of Cervical Histology Among Women With Human Immunodeficiency Virus In Fection Receiving Care At A Terciary Centre In South-South Nigeria

Sapira-Ordu Leesi¹, Sapira Monday Komene^2
1Department Of Obstetrics And Gynaecology, Rivers State University Teaching Hospital, Forces Avenue, Port Harcourt.
²Department Urology, University Of Port Harcourt Teaching Hospital, Port Harcourt.

ABSTRACT
BACKGROUND
The transitional area of the cervix has variable histological features due to constant changes following irritation by hormones, infection as well as trauma. These changes range from squamous metaplasia to cervical intraepithelial neoplasia and invasive cancers. Women with HIV infection are prone to premalignant and malignant lesions of the cervix due to immunosuppression and persistent co-infection with the highly oncogenic human papilloma virus serotypes. They are therefore thought to be sexually transmitted and they contribute significantly to reproductive ill-health and mortality among women.
OBJECTIVE
This was to determine the actual prevalence of precancerous and cancerous lesions of the cervix using histological assessment among HIV positive women receiving care at the University of Port Harcourt Teaching Hospital (UPTH), Alakahia between August and June 2015.
MATERIALS AND METHODS
One hundred HIV positive women on highly active antiretroviral therapy (HAART) were recruited randomly for the study with an uptake rate of 96%. Informed consent was obtained and data collected using a semi-structured questionnaire. They all had cervical biopsies and the specimens were processed by the histotechnologist and reported by the histopathologist. Data analysis was done using SPSS.
RESULTS
The mean age of patients was 37.0 ± 6.6 years and the mean age of those with dysplasia was 38.1 ± 6.6 years. The age range of the patients was 21-56 years with the highest number of respondents (27.1%) in the 30- 34 years group. This was closely followed by 35-39 years with 26.0%. Majority of the patients (49.0%) were married and the others were either single, divorced or widowed. Most of the patients had at least secondary education (38.5% and 37.5% for tertiary and secondary levels of education respectively). The parous women weresixty (62.5%) while the nulliparous women were thirty six(37.5%).Thirty-four (35.4%) of the respondents had their first sexual intercourse before eighteen years of age while fifty-five (57.3%) had it after the age of eighteen. Seven (7.3%) had no idea of their age at first sexual exposure. Nineteen (19.8%) of them had five or more lifetime sexual partners while sixty-six (68.8%) had two to four sexual partners. Six (6.2%) have had one and five (5.2%) did not respond.Seventeen (17.7%) of the respondents had CD4 counts less than 250 cells/mm3, thirty (31.3%) had values between 250 to 499 cells/mm3 while forty-nine (51.0%) had 500 cells/mm3 and above. Thirty-six (37.5%) were normal, twenty (20.8%) had cervicitis, twenty-three (24.0%) had CIN I, ten (10.4%) had CIN II, six (6.3%) had CIN III and one (1.0%) had endocervical polyp.
CONCLUSION: There is need for women with HIV infection to be screened regularly considering the high prevalence of cervical intraepithelial neoplasia among them.

Key Words: Cervical, histology, HIV, CIN, malignancy, pattern, South-South, women.

INTRODUCTION

The cervix is the lowermost portion of the uterus whichis composed mainly of fibrous tissues with an average of 10 to 15% of smooth muscle fibers. It is covered by stratified squamous epithelium up to the internal os where it changes abruptly to the columnar type. This transitional area, also known as the transformation zone has variable histological features which change constantly following irritation, hormonal changes as well as infection and trauma. Thus, this zone is predisposed to severe dysplasia, carcinoma in situ and even invasive carcinoma.1
Worldwide, cervical cancer is the fourth most common cancer among women with an estimate of approximately 570,000 new cases and 311,000 deaths (in 2018) with a standardized incidence of 13.1 per 100,000 women.2 More than 85% of the global burden of the disease occur in the low and middle income countries.3

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