S K Njagi1, N R Mugo2, A J Reid3, S Satyanarayana4, K Tayler-Smith3, W Kizito3, J Kwatampora1, W Waweru1, J Kimani1, J S Smith5. 1. Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya. 2. Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. 3. Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg. 4. International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India. 5. University of North Carolina, Chapel Hill, North Carolina, USA.
Abstract
SETTING: Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya. OBJECTIVE: In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012. DESIGN: Prospective nested cohort study. RESULTS: Of the 350 women enrolled, the median age was 29 years (range 18-49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infected women were 2.7 times (95%CI 1.7-4.4) more likely to have CIN than non-HIV-1-infected women. Among HIV-1-infected women, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2-5.1) and seven times (95%CI 2.3-23.3) greater than among non-HIV-infected women. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infected women. CONCLUSION: The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.
SETTING: Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya. OBJECTIVE: In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012. DESIGN: Prospective nested cohort study. RESULTS: Of the 350 women enrolled, the median age was 29 years (range 18-49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infectedwomen were 2.7 times (95%CI 1.7-4.4) more likely to have CIN than non-HIV-1-infectedwomen. Among HIV-1-infectedwomen, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2-5.1) and seven times (95%CI 2.3-23.3) greater than among non-HIV-infectedwomen. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infectedwomen. CONCLUSION: The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.
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