Prevalence of Cervical Dysplasia in HIV-Positive and HIV-Negative Women at the Sihanouk Hospital Center of HOPE, Phnom Penh , Cambodia

Abstract

Introduction: There is a high burden of cervical cancer in Cambodia, yet published data on the prevalence of cervical<br />dysplasia and the risk factors contributing to the development of pre-cancerous lesions in Cambodian women is very<br />limited. In addition, as it is well known that HIV positivity increases cervical cancer risk, it is important to quantify<br />the prevalence of cervical dysplasia and carcinoma among Cambodian women living with HIV disease. Methods: A<br />cross-sectional study was conducted with a sample of 499 HIV+ and 501 HIV- Cambodian women at the Sihanouk<br />Hospital Center of HOPE. Visual inspection with 5% acetic acid was the method of screening. Colposcopy was performed<br />on all VIA+ patients, and subsequent treatment followed WHO guidelines. Logistic regression models, stratified by<br />both HIV+ and HIV- groups, were used to assess significant factors associated with having dysplasia. Results: VIA+<br />results were prevalent in both the HIV+ and HIV- arms of the study. The HIV+ patients were more likely to have a<br />lower age at coitarche, lower weight, 2 or more lifetime sexual partners, two or greater pregnancies, or be unmarried.<br />The estimated prevalence of VIA detected cervical dysplasia was 11% for the entire study sample, 13.4% in the HIV<br />positive (HIV+) group and 8.6% in the HIV negative (HIV-) group (OR: 1.65; 95% CI: 1.10, 2.48; p=0.01). For the<br />HIV+ group, having a history of 4 or more full-term pregnancies (OR: 3.42; 95% CI: 1.01-11.64; p=0.049) was found<br />to be significantly associated with having an increased risk of developing cervical dysplasia in the multivariate model.<br />Conclusion: Cervical dysplasia is prevalent in both HIV positive and negative Cambodian women and a VIA based<br />national screening programs need to be developed and expanded to provide access to affordable and effective treatment<br />for cervical dysplasia and cancers.