HIV and development of epithelial cell abnormalities in women with prior normal cervical cytology in Nigeria

Jonah Musa*, Supriya D. Mehta, Chad J. Achenbach, Charlesnika T. Evans, Neil Jordan, Francis A. Magaji, Victor C. Pam, Patrick H. Daru, Olugbenga A. Silas, Atiene S. Sagay, Rose Anorlu, Yinan Zheng, Mamoudou Maiga, Isaac F. Adewole, Robert L. Murphy, Lifang Hou, Melissa A. Simon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: HIV-associated cellular immune dysfunction has been linked to higher risk of cervical dysplasia and cancer in HIV infected women. We sought to understand the relationship between HIV and development of epithelial cell abnormalities (ECA) at follow-up in women with prior normal cervical cytology (NCC). Methods: Retrospective cohort analysis of women who received a Pap test at the Operation Stop Cervical Cancer Unit in Jos, Nigeria over a 10-year period (2006-2016). We analyzed the data of women with NCC at first Pap who had at least one follow-up cytology result for time-to-detection of ECA. We determined follow-up time in years from date of first NCC to date of first ECA report or date of last NCC follow up report with censoring at last follow-up date or December 31st, 2016 whichever came first. The primary outcome was development of any ECA as defined by the Bethesda 2001 reporting system. We identified demographic and clinical factors associated with incident ECA using multivariable Cox regression. Results: A total of 1599 women were eligible for this analysis. Overall, 3.7% (57/1556) of women reported being HIV infected. The median age at first Pap was 39 years (IQR; 33-45). The HIV infected women were younger (36.3 ± 8.1) compared to those uninfected (39.3 ± 6.6), p = 0.005. After an accrued follow-up time of 3809 person-years (PYs), 243 women (15%) had an ECA with an event rate of 6.38 per 100 PYs. Women ≥35 years at first Pap were more likely to have an ECA compared to those < 35 years (7.5 per 100 PYs vs 3.8 per 100 PYs, HR = 1.96; 95% CI: 1.4, 2.8). HIV status was not significantly associated with developing ECA in either unadjusted (7.4 per 100 PYs vs 6.4 per 100 PYs, HR = 1.17; 95% CI: 0.53, 2.3) or adjusted analyses (aHR = 1.78; 95% CI: 0.87, 3.65). Conclusion: Women living with HIV and on successful antiretroviral treatment may not have a differential hazard in the development of ECA during follow up after a prior normal Pap. Offering a repeat CCS to women who are 35 years or older irrespective of HIV status is likely an effective strategy in resource limited settings.

Original languageEnglish (US)
Article number50
JournalInfectious Agents and Cancer
Issue number1
StatePublished - Jul 29 2020


  • Cervical cancer screening
  • Epithelial cell abnormalities
  • HIV
  • Normal cervical cytology

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology
  • Cancer Research
  • Epidemiology


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