Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India

• Published in: International journal of STD & AIDS 2019-05, Vol.30 (6), p.586-595
• Main Authors: Shin, Sanghyuk S, Carpenter, Catherine L, Ekstrand, Maria L, Wang, Qiao, Grover, Surbhi, Zetola, Nicola M, Yadav, Kartik, Sinha, Sanjeev, Nyamathi, Adeline M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; AIDS/HIV; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - virology; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - virology; Female; Health Knowledge, Attitudes, Practice - ethnology; HIV Infections - complications; HIV Infections - ethnology; Humans; India - epidemiology; Middle Aged; Papanicolaou Test; Papillomaviridae - isolation & purification; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Prevalence; Risk Factors; Rural Population - statistics & numerical data; Squamous Intraepithelial Lesions of the Cervix - diagnosis; Squamous Intraepithelial Lesions of the Cervix - epidemiology; Squamous Intraepithelial Lesions of the Cervix - virology; Surveys and Questionnaires; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - virology; Vaginal Smears; Young Adult
• ISSN: 0956-4624; 1758-1052
• DOI: 10.1177/0956462419825950

Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.