Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania|
Obure, J.; Olola, O.; Swai, B.; Mlay, P.; Masenga, G. & Walmer, D.
Cervical cancer is the second most common cancer in women worldwide and the leading
cause of cancer deaths in Tanzanian women. Prevention of cervical cancer relies on the detection
and treatment of Squamous Intraepithelial Lesion (SIL), a premalignant disease stage. Worldwide
there are overwhelming reports associating SIL and HIV infection, however in Tanzania such reports
are limited. A cross-sectional hospital-based descriptive study was conducted to determine the
prevalence and severity of SIL in 234 HIV seropositive and seronegative women aged 18-68 years old
at Kilimanjaro Christian Medical Centre in northern Tanzania. A structured questionnaire was used
to collect sociodemographic data. In addition, blood was collected for rapid HIV antibody testing and
CD4+ T-lymphocyte counts to associate with prevalence and severity of SIL from the cervical smear
collections. A total of 214 subjects had smear results regarded as valid for interpretation, of which
46.3% were HIV seropositive. Overall rate of SIL was 17%. Proportion of SIL among HIV seropositive
subjects was 32% versus 4% in seronegative subjects (OR=13.3, 95% CI=4.2-46.4). Low CD4+ Tlymphocyte
cell count was associated with higher prevalence of SIL (P=0.001). The relationship
between CD4+ T-lymphocyte cell counts and the severity of cervical SIL was significant (P=0.007).
Marital status and number of lifetime sex partners were risk factors significantly associated with SIL
(P=0.004 and 0.005, respectively). SIL was not associated with age, education level, parity or age at
sex debut. The prevalence and severity of cervical SIL was significantly associated with HIV infection
and immunologic disease progression. These findings underscore the need for HIV screening among
women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status
and number of lifetime sex partners were significant risk factors associated with SIL.
HIV, cervical cancer, squamous intraepithelial lesion, risk factors, Tanzania