Myanmar Health Sciences Research Journal
Short Reports :
Myanamr Health Research Registration 2020; 32(2): 185-186.
DOI: DOI: https://doi.org/10.34299/mhsrj.009101

Abnormal Cervical Cytology Patterns among Human Immunodeficiency Virus-Infected Women Attending Anti-retroviral Therapy Center of PyinOoLwin Township

Nandar Ko, Haung Naw, Than Than Maw, TheiThei Moe Han, KyawKo Ko Htet, Khin Moe Aung, KyawZin Linn & Win Naing

Myanmar Health Sciences Research Journal, 2020; 32(2): 185-186

ABSTRACT

RESULT
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INTRODUCTION
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Myanmar is one of the high Human Immunodeficiency Virus (HIV) prevalence areas of the world. In 2016, the prevalence of HIV among reproductive aged 15-49 years was 0.6%.1Cervical cancer is the fourth most common cancer in women. In 2012, it was estimated to be 528,000 new cases and 266,000 deaths worldwide. Almost 87% of cervical cancer deaths occur in the less developed regions.2Compared with general population, HIV-infected women are about 3 times more likely to be diagnosed with cervical cancer.3The rate increased with immunosupresssion.4

The aim of this study is to study abnormal cervical cytology patterns among HIV-infected women attending Anti-retroviral Therapy center of PyinOoLwin Township. A cross-sectional descriptive study was carried out on 400 adult HIV-positive women (18 years and above) attending ART center of PyinOoLwin Township during July 2018 and June 2019 were included in this study. The sample size was calculated by one sample proportion method and total 400 HIV-infected women were selected randomly. Known case of cervical cancer was excluded in this study.

Cervical cells were taken by using disposable Ayre's spatula. The smear slides were stained with Papanicolaou (Pap) stain and examined under light microscope. The interpretation of result was done by using Bethesda System (2014).5 In this study, the mean age of participants was 39.8±9.5 years, and mean age of first coitus was 22.2±5.4 years. According to cervical cytology results, 358/400 (89.5%) were negative for intraepithelial lesion ormalignancy (NILM) and 42/400(10.5%) were epithelial cell abnormality (ECA). Among ECA, 30(7.5%) cases were low-grade squamous intraepithelial lesion (LSIL), 3(0.8%) cases were high-grade squamous intraepithelial lesion (HSIL), 8(2%) cases were atypical squamous cells of undetermined significance (ASC-US) and 1(0.2%) case was atypical squamous cells cannot exclude HSIL (ASC-H).

The most of the HIV-infected women in this study had no history of taking cervical Pap smear, and they were regular menstrual cycle, single married, no history of smoking, no history of abnormal bleeding per vagina and not easily bleed on touch cervix. Mean duration of HIV infection was 4.7±3.9 years, mean duration of ART treatment was 3.6±3.1years and mean CD4 count was 459.7±260.9 cells/mm3. According to these result, most of the women in this study were good in clinical conditions. So, in this study,the prevalence of abnormal cervical cytology was lower than estimated prevalence.


This study shows that high percentage of inflammatory smears, reactive cellular changes associated with inflammation 311/400 (77.8%). In this study, elderly HIV-infected women show atrophic smear (8/400, 2%). Squamous metaplasia (25/400, 6.2%) was also found among the non-neoplastic cellular variations.

Among the organisms can be examined in cervical cytology, only the flora suggestive of bacterial vaginosis (BV) (14/400, 3.5%)was revealed in this study. BV is the most common vaginal disorder among women of reproductive age. Evidence regarding an association between BV and cervical pre-cancerous lesions has so far been conflicting and is still a matter of debate.

This study also investigated the association between abnormal cervical cytology results and clinical characteristics such as age, age of first coitus, smoking, abnormal bleeding per vagina etc. Among them, abnormal cervical cytology results were highly statistically significant (p=0.006) with history of post coital bleeding and redness of cervix and borderline significant (p=0.05) with easily bleed on touch of cervix on vaginal examination. It was already known that these factors are the signs and symptoms of precancerous lesions. The other clinical variables were not significantly associated with the abnormal cervical cytology results.

There are some limitations such as one study area, conventional Pap smear method and current CD4 counts record availabilities. The result of abnormal cervical smear will be increased by using modern ThinPrep preparation or liquid-based cytology methods of Pap smear.Myanmar is the developing country and the prevalence of HIV and cervical cancer is high as mentioned above. So, it is needed to find out early screening of cervical cancer in HIV-infected women in Myanmar and stress in periodic Pap smear screening in this high-risk population to decrease the burden of cervical cancer. Health education should be provided to HIV-infected women for early screening of cervical cancer who have history of relevant clinical signs and symptoms. The further similar study with larger sample size, extended study area and preferred cervical cytology method (eg. liquid-based cytology) is needed to get more representative basedline data for Myanmar.


SUPPLEMENTARY MATERIAL
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DISCUSSION
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ACKNOWLEDGMENT
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CONFLICT OF INTEREST
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Competing interests

The authors declare that they have no competing interests.


REFERENCES
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  1. National AIDS Program. Annual Progress Report on National HIV/AIDSResponse.Nay Pyi Taw, Department of Public Health, Ministry of Health and Sports, Myanmar. 2015.
  2. IARC. Cancer Fact Sheets: Cervical Cancer: Cervical Cancer Estimated Incidence, Mortality and Prevalence (5 Years) Worldwide in 2012. IARC, WHO, GLOBOCAN 2012. [Internet] (accessed4/5/2018) Available from: http://gco.iarc.fr/today/data/pdf/fact-sheets/ cancers/cancer-fact-sheets-16.pdf
  3. Hernandez RU, et al. Cancer risk in HIV- infected people in the USA from 1996-2012: A population based, registry linkage study. Lancet HIV 2017; 4(11): e495-e504 doi: 10.1016/S2352-3018(17) 30125-X
  4. Abraham, et al. Invasive cervical cancer risk among HIV-infected women: A North American multi-cohort collaboration prospective study. Journal of Acquired Immune Deficiency Syndromes 2013; 62(4): 405-413.
  5. Nayar R & Wilbur DC. The 2014 Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory