High Risk Human Papilloma Virus Genotyping and Cervical Cytology as Screening Tests for Cervical Cancer in Human Immunodeficiency Virus Positive Women in Nigeria

Abstract

Introduction: The integration of high risk oncogenic strains of human papillomavirus into the genome of cells in the cervix results in specific cytopathic changes. The propensity for dysplastic changes is worst in the presence of depressed immunity. Aim: To compare screening methods by the identification of oncogenic strains of human papillomavirus (hrHPV) in cervical smears and the cytopathic changes among human immunodeficiency virus (HIV) positive patients. Study Design: Prospective cross-sectional study Place and duration: Antiretroviral clinic and Cancer screening centre of the University of Port Harcourt Teaching Hospital, between 24th October- 30th of December, 2014. Methodology: Eighty -two HIV positive women from the antiretroviral clinic with an equal number of HIV negative women were recruited as control. The presence of hrHPV genotypes were identified using real time polymerase chain reaction technique. Cytological examination of cervical smears was done. The information obtained was processed using the SPSS version 20 software. Results are presented in tables, test validity computed, test of significance and association done using student’s t-test and Odds ratio with P value < 0.05. Results: HrHPV strains were more common among HIV infected women (P=0.03 OR 3.34 CI 1.03-10.84). High grade intraepithelial neoplasia was significantly associated with hrHPV (P=0.006, OR 14.75 CI 2.32-93.91). HrHPV genotyping as a screening test was 88% specific with negative predictive value of 96.7% (CI 0.89-1.0) for determining high grade intraepithelial lesions Conclusion: Human immunodeficiency virus infected women are associated with higher risk of acquiring highly oncogenic strains of HPV. High risk HPV genotyping with high specificity and negative predictive values in identification of patients with dysplastic changes should be used as adjunct to cytological screening in HIV positive patients.