A comparative study of Pap smear findings among HIV positive and negative women at Government Hospital of Thoracic Medicine (GHTM), Tambaram

Background

Cancer cervix is a major health problem in India, accounting for 26.1-43.8% of all cancers in Indian women. Dysplasia on Pap smear has been reported in 15-40% of HIV positive women which is 10-11 times higher than those observed among HIV negative women. Patients with persistent inflammatory Pap smears harbor high proportion of HPV infection and cervical intraepithelial neoplasia (20.9%). The purpose of this present study was to compare Pap smear findings in HIV-infected and uninfected women at GHTM and to correlate the Pap smear abnormalities among HIV positive women with their immune status.

Methodology

All women (18-45 years of age), admitted at GHTM, between July-Sept. 2010, consented were selected and Pap smear was performed. Smears were reported by a pathologist blinded to the HIV status of patients. Results were analyzed by using PASW 18 version.

Results

Total 300 samples were collected in which 204 were HIV positive and 96 were HIV negative. HIV positive women (58.8%) had more Pap smear abnormalities such as cervical dysplasia (3.92%), inflammatory smear (51.96%), infection (2.94%) (p=0.010) when compared with HIV negative women (43.75). Among HIV positives 63.93% had CD4 count less than 250 (p=0.048), and 64.3% had coexisting opportunistic infection (p=0.04). On speculum examination, cervicitis was present in 63.3% of HIV positive women with abnormal pap smears (p=0.004).

Conclusion

This study showed a high percentage of inflammatory Pap smears (51.96%) among HIV positives. Hence these patients will require a follow up Pap smear and colposcopy and biopsy if inflammation is persistent to exclude cervical cancer.