A Study of Pap Smear in HIV-Positive Females

Comparison of Papanicolaou Smear Tests Among HIV Negative and HIV Positive Pregnant Women on HAART at a Tertiary Hospital

Background

Cervical cancer is the most common gynaecological cancer worldwide, causing morbidity and mortality, especially in developing countries like Nigeria. It develops from premalignant lesions of the cervix. Human immune deficiency virus (HIV) increases the risk of dysplastic changes in the cervix. Pregnant HIV-positive women may be at a higher risk of having pre-invasive cervical lesions. Pregnancy presents an opportunity to screen women for premalignant lesions of the cervix using a Papanicolaou (Pap) smear, especially in an environment like ours where women of reproductive age have poor health-seeking behaviour. The objective of this study is to compare the cytological patterns of Pap smear of pregnant women who are HIV positive compared to their HIV negative counterparts at the antenatal clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA).

Methodology

This is a comparative cross-sectional study that involved performing Pap smears on consenting HIV-positive pregnant women on HAART and HIV-negative pregnant women attending the antenatal clinic of AE-FUTHA. One hundred pregnant HIV-positive women on HAART and one hundred pregnant HIV-negative women who met the inclusion criteria and gave consent were recruited into the study by consecutive sampling method. A pretested questionnaire was administered to the women. A pap smear test was carried out on each of the participants. The data was analysed using Epi info version 7.2.1. Continuous variables were presented as mean and standard deviation while categorical variables were presented as numbers and percentages. Categorical variables were analysed using Chi-square (Fisher's exact test was also used), while means were compared using a t-test. A P-value ˂ 0.05 was considered as statistically significant.

Results

The prevalence of abnormal Pap smear among pregnant women in AEFUTHA was 14%. The prevalence among HIV-positive pregnant women was 24% while the prevalence for HIV-negative women was 4%. This difference was statistically significant (P value was <0.001).

Conclusion

This study has demonstrated the presence of premalignant cervical lesions in pregnant women with a significantly higher prevalence among HIV-positive pregnant women. Therefore, there is a need to incorporate Pap smear tests among routine antenatal investigations, especially for HIV-positive pregnant women.

PAP Test Versus Colposcopy for Cervical Cancer Screening in HIV-Seropositive Women: A Case-Control Study

Purpose

The prevalence of pre-invasive lesions (PIL) of cervix in human immunodeficiency virus (HIV)-seropositive women ranges from 12.5 to 69%. Although Papanicolaou (PAP) test is the recommended screening method, it has concerns owing to high false-negative cytology in HIV-infected women and is associated with high attrition rates. The current study aims to compare the role of routine colposcopy with PAP test at initial visit for screening of pre-invasive lesions of cervix in HIV-seropositive women.

Methods

A cross-sectional study of 120 HIV-seropositive women aged 25-50 years and screened for PIL of cervix by PAP test and colposcopy simultaneously was conducted. Colposcopy-directed biopsy was taken if SWEDE score was ≥ 5, and the results were compared with PAP report as well as the histopathology findings.

Results

Out of the 120 women screened, abnormal colposcopy was found in 22 women (18.3%) out of which 12 (54.54%) were positive for PIL of cervix on biopsy as well. Abnormal PAP test was found in 6 women (5%), and all had abnormal colposcopy and histopathological findings suggestive of PIL as well. There were 6 women with PIL of cervix who would have been missed if only PAP test was to be used as the screening modality.

Conclusion

Colposcopy was superior in detection of PIL of cervix in HIV-seropositive women. Therefore, the authors conclude that colposcopy should be incorporated as a primary screening tool for pre-invasive lesions of cervix in HIV-seropositive women.

Factors associated with normal or abnormal Papanicolaou smear among HIV-infected women at a national hospital in Lima, Peru, 2012-2015

HIV-infected women are at a risk of developing abnormal lesions of the uterine cervix. The objective of this study was to determine factors associated with normal or abnormal Papanicolaou (Pap) smear among HIV-infected women. A case-control study was conducted; case and control were defined as HIV-infected women ≥18 years with an abnormal and normal Pap smear, respectively. A logistic regression analysis was performed, and the Odds Ratio (OR) was calculated with its 95% Confidence Interval (CI). We included 368 patients, and the mean age was 36.83 years (SD ± 9.81), similar between cases and controls. Regarding cases, 30.50% (n = 43) had an alcohol consumption (AC), 75.18% (n = 106) were on antiretroviral therapy (ART) and 37.74% (n = 40) were in virologic failure (VF). About controls, 18.02% (n = 41) had AC, 85.02% (n = 193) were on ART, and 23.12% (n = 40) were in VF. In multivariate analysis, AC [OR: 1.77 (1.06-2.95)], VF [OR: 2.41 (1.55-3.74)], and ART [OR: 0.07 (0.02-0.23)] were significant factors. The risk factors associated with an abnormal Pap smear were AC and VF. ART was a protective factor. Therefore, besides scheduled Pap smear, human papillomavirus screening/immunization, VF, and ART should be strictly reinforced, and AC should be mitigated.

Study of Prevalence of Abnormal Pap Smear and its Associated Risk Factors in HIV Positive Women: A Cross-sectional Study

Objective

1. To determine the prevalence of pre malignant cervical lesions in HIV positive women using conventional Pap smear. 2. To determine the association between various risk factors in HIV positive women and abnormal cytology on Pap smear.

Design

A cross-sectional study was conducted in Bangalore Medical College in which eligible HIV-positive women underwent Pap smear, human papillomavirus (HPV) testing and cervical biopsy.

Methods

Retropositive women attending gynaec OPD during the study period were taken into the study after taking informed consent. Women who fulfilled the inclusion criteria were subjected to Pap smear. Bethesda system of classification was used for reporting the Pap smear. Women with abnormal Pap smear were further evaluated by HPV DNA testing and cervical biopsy.

Results

Cervical cytology was abnormal in 30% of the HIV-positive women, out of which 10% had HSIL, 15% had LSIL and 5% had ASCUS. Age at first sexual intercourse < 17 years (p = 0.009), past H/O STI (p = 0.0001), women with husband's having multiple sexual partners (p = 0.0001), women with CD4 count < 350 cells/micro-litre (p = 0.0001) were significant risk factors associated with abnormal Pap smear.

Conclusion

Invasive cervical cancer is considered a preventable disease because of its long preinvasive state. Therefore, screening for premalignant cervical lesions represents an opportunity to prevent women developing cervical carcinoma.

Screening for cervical cancer in HIV-infected women: A review of literature

Globally, the cervical cancer burden is huge, more so in low-resource countries. Human immunodeficiency virus (HIV) infection increases a woman's risk of human papillomavirus (HPV) infection and cervical cancer. There is a lack of opportunistic, as well as, organized cervical cancer screening structure for HIV-positive women. A large proportion of women have invasive cervical cancer as their initial acquired immune deficiency syndrome (AIDS)-defining illness. There is an especially high-incidence in countries where there are no organized cervical cancer prevention programs. Additionally, there are cultural, social, psychological, and system barriers that women living with HIV have to overcome when accessing healthcare services. We believe that educating women and healthcare providers regarding the need for screening, early detection, and treatment is as important as bringing about a systematic change in healthcare services to improve participation of HIV-positive women in screening for cervical cancer.

Modified Papanicolaou staining for oral swab samples stored long term

Pathologists collect swab samples for Papanicolaou (Pap) staining to diagnose various diseases including cancer and HIV. Time constraints and limited resources, may preclude staining a sample immediately. To re-confirm results, samples must be frozen for later analysis. We present a method for Pap staining cells that have been stored long term. An effective method for Pap staining of frozen cells should enable flexibility for processing samples.

A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India

OBJECTIVES

The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ2 test was used to analyze the data and a p value < 0.05 was considered to be significant.

RESULTS

Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34-49 years. CD4 cell counts fell in the range of 200-500 cells/mm3 in most of the HIV-positive patients (68.75%), but was not found to be statistically significant.

CONCLUSION

Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200-500 cells/mm3.