Prevalence of abnormal pap smear results in correlation with CD4 counts in an HIV positive cohort in Phnom Penh, Cambodia
Lim, K Harwell, J De Munter, Paul Srey, P Thay, S Haverkamp, M Tharpe, L Jacques, G Lynen, L Cu-Uvin, S #
International AIDS Society edition:XVI location:Toronto, Canada date:2006
Background: HIV-infected women have been shown to have an increased incidence of cervical dysplasia/cancer. This increased risk is associated with concurrent HPV infection. With marriage being an important risk factor for HIV infection in Cambodian women, STDs may not be as prevalent as in other HIV positive populations. To date no data on HPV prevalence or abnormal Pap smear rates in Cambodia has been published. This study sought to evaluate the prevalence of abnormal pap smears in correlation with immunosuppression.
Methods: During 2005, 268 HIV-infected women in a Women´s HIV clinic in Phnom Penh, Cambodia, were screened for cervical dysplasia/cancer by Pap smear and had their CD4 count measured. Pap smears were then read via telepathology at the University of Basel, Switzerland, Pathology Department based on the Bethesda classification. CD4 counts were done locally. For statistical analysis Fisher’s exact test was used to compare the two groups.
Results: Demographics of the women: mean age = 32 yrs (18-53), mean CD4 count = 284/mm3 (2-1221), 112/268 (42%) had CD4 counts below 200/mm3, 117/268 (44%) received HAART, including 67/112 (60%) of patients with CD4<200/ mm3 and 50/156 (32%) of patients with CD4 >200/ mm3. 7 patients had incomplete data. Out of the 261 women, 8 (3%) women had HGSIL, 7 with CD4 below 200/ mm3, 1 with CD4 over 200/ mm3 (p-value 0.008), 13 (5.0%) women had LGSIL, 8 with CD4 below 200/ mm3 and 5 with CD4 over 200/ mm3 (p-value 0.014).
Conclusions: HGSIL on Pap smear appears to be strongly correlated with immune-suppression in this cohort. The results show the importance of screening for cervical cancer all HIV positive women, even when in resource-poor settings. Further studies are needed to correlate the findings with HPV prevalence and to confirm these diagnoses by colposcopy or biopsy.