Cervical cancer risk factors among HIV-infected Nigerian women

Background: Cervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Cervical cancer is an AIDS-defining cancer; however, HIV only marginally increases the risk of cervical pre-cancer and cancer. In this study, we examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria. Methods: A total of 2,501 HIV-positive women participating in the cervical cancer screen-and-treat program in Abuja, Nigeria consented to this study and provided socio-demographic and clinical information. Log-binomial models were used to calculate relative risk (RR) and 95% confidence intervals (95% CI) for the risk factors of cervical pre-cancer and cancer. Results: There was a 6% prevalence of cervical pre-cancer and cancer in the study population of HIV-positive women. The risk of screening positivity or invasive cancer diagnosis reduced with increasing age, with women aged 40 years and older having the lowest risk (RR=0.4; 95% CI=0.2-0.7). Women with a CD4 count of 650 per mm(3) or more also had lower risk of screening positivity or invasive cancer diagnosis (RR=0.3, 95% CI=0.2-0.6). Other factors such as having had 5 or more abortions (RR=1.8, 95% CI=1.0-3.6) and the presence of other vaginal wall abnormalities (RR=1.9, 95% CI=1.3-2.8) were associated with screening positivity or invasive cancer diagnosis. Conclusion: The prevalence of screening positive lesions or cervical cancer was lower than most previous reports from Africa. HIV-positive Nigerian women were at a marginally increased risk of cervical pre-cancer and cancer. These findings highlight the need for more epidemiological studies of cervical cancer and pre-cancerous lesions among HIV-positive women in Africa and an improved understanding of incidence and risk factors.