The effect of human immunodeficiency virus prevalence on the epidemiology of conventional cervical cytological abnormalities : an institutional experience

Abstract

OBJECTIVES: Despite a shift towards other screening modalities, cervical cytology still has an important screening function in many settings. The worldwide human immunodeficiency virus (HIV) epidemic has impacted severely on cervical cancer, resulting in women presenting at a younger age with more advance disease and poorer prognosis. The objective of this study was to compare different datasets from different time periods to assess the possible impact of HIV infection on the epidemiological characteristics of conventional cervical cytology screening results. DESIGN: The design was a comparative overview of two different cervical cytology datasets collected at different times. SETTINGS AND SUBJECTS: Conventional cervical cytology screening data from non-pregnant patients at the gynaecological outpatient service of the Pretoria Academic Complex from 1991-2000, and data from pregnant patients attending the Kalafong Hospital antenatal clinic in 1993-1994 and 2008, were analysed. OUTCOME MEASURES: Abnormal smear rates, the distribution of different abnormal smears and HIV prevalence in pregnant women taking part in the annual, National Antenatal Sentinel HIV and Syphilis Prevalence Survey. RESULTS: The high prevalence of HIV in South Africa is associated with a higher prevalence of abnormal smears. It is also associated with a change in the distribution of detected abnormalities. High-grade squamous intraepithelial lesions (HSIL) are now much more common than low-grade squamous intraepithelial lesions (LSIL). The most pronounced change has been a shift in the ratio of LSIL to HSIL, where the value has changed from > 1 to < 1. CONCLUSION: The rate of abnormal smears as well as the distribution of abnormalities of conventional cervical cytology in South Africa has changed. It is possible that this change is associated with the high prevalence of HIV infection.