Obure J, Olola O, Swai B, Mlay P, Masenga G, Walmer D
Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania.
Tanzan J Health Res. 2009 Oct;11(4):163-9. doi: 10.4314/thrb.v11i4.50143.
Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in Tanzanian women. Prevention of cervical cancer relies on the detection and treatment of Squamous Intraepithelial Lesion (SIL), a premalignant disease stage. Worldwide there are overwhelming reports associating SIL and HIV infection, however in Tanzania such reports are limited. A cross-sectional hospital-based descriptive study was conducted to determine the prevalence and severity of SIL in 234 HIV seropositive and seronegative women aged 18-68 years old at Kilimanjaro Christian Medical Centre in northern Tanzania. A structured questionnaire was used to collect sociodemographic data. In addition, blood was collected for rapid HIV antibody testing and CD4+ T-lymphocyte counts to associate with prevalence and severity of SIL from the cervical smear collections. A total of 214 subjects had smear results regarded as valid for interpretation, of which 46.3% were HIV seropositive. Overall rate of SIL was 17%. Proportion of SIL among HIV seropositive subjects was 32% versus 4% in seronegative subjects (OR = 13.3, 95% CI = 4.2-46.4). Low CD4+ T-lymphocyte cell count was associated with higher prevalence of SIL (P = 0.001). The relationship between CD4+ T-lymphocyte cell counts and the severity of cervical SIL was significant (P = 0.007). Marital status and number of lifetime sex partners were risk factors significantly associated with SIL (P = 0.004 and 0.005, respectively). SIL was not associated with age, education level, parity or age at sex debut. The prevalence and severity of cervical SIL was significantly associated with HIV infection and immunologic disease progression. These findings underscore the need for HIV screening among women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status and number of lifetime sex partners were significant risk factors associated with SIL.
宫颈癌是全球女性中第二常见的癌症，也是坦桑尼亚女性癌症死亡的主要原因。宫颈癌的预防依赖于对鳞状上皮内病变（SIL）的检测和治疗，这是一个癌前疾病阶段。全球有大量报告将SIL与HIV感染联系起来，然而在坦桑尼亚，此类报告有限。在坦桑尼亚北部的乞力马扎罗基督教医疗中心，开展了一项基于医院的横断面描述性研究，以确定234名年龄在18至68岁之间的HIV血清阳性和血清阴性女性中SIL的患病率和严重程度。使用结构化问卷收集社会人口学数据。此外，采集血液进行快速HIV抗体检测和CD4+T淋巴细胞计数，以便与宫颈涂片采集的SIL患病率和严重程度相关联。共有214名受试者的涂片结果被视为可有效解读，其中46.3%为HIV血清阳性。SIL的总体发生率为17%。HIV血清阳性受试者中SIL的比例为32%，而血清阴性受试者中为4%（比值比=13.3，95%置信区间=4.2-46.4）。CD4+T淋巴细胞计数低与SIL的较高患病率相关（P=0.001）。CD4+T淋巴细胞计数与宫颈SIL的严重程度之间的关系显著（P=0.007）。婚姻状况和终身性伴侣数量是与SIL显著相关的危险因素（分别为P=0.004和0.005）。SIL与年龄、教育水平、产次或首次性行为年龄无关。宫颈SIL的患病率和严重程度与HIV感染和免疫疾病进展显著相关。这些发现强调了对患有SIL的女性进行HIV筛查的必要性，以及对HIV感染女性进行宫颈癌筛查的必要性。婚姻状况和终身性伴侣数量是与SIL相关的重要危险因素。
