A retrospective review of cervical smears in Human Immunodeficiency Virus infected postnatal women at Johannesburg Hospital
Date
2011-03-16
Authors
Wise, Amy Juliet
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Abstract
Introduction
Against the high background rate of HIV among our antenatal clinic attendees, 30.3% in
Gauteng in 2007, and the importance of cancer of the cervix as a health issue; this study was
undertaken to determine the rate of abnormality found in cervical smears performed on HIV
positive women attending the postnatal clinic at Johannesburg Hospital. The degree of
abnormality and where possible its management, was reviewed. Secondly it was determined
whether the immune status, namely the WHO clinical stage, CD4 cell count and viral load,
correlated with the Pap smear results. Lastly patients were also analyzed according to the
treatment received for HIV and their Pap smear results.
Patients and Methods
The study is a retrospective record review. All the patients who attended the postnatal clinic
(PNC) between October 2005 and the end of July 2006, who had a Pap smear, were included.
Follow-up test results were collected to the end of June 2007. A total of 324 patients attended the
clinic in the study time period, of which 248 (76.5%) had a Pap smear done and 76 (23.5%) did
not.
iv
Results
The main results of interest were as follows – 131 patients (52.8%) had normal Pap smears,
64(25.8%) had LGSIL, 32 (12.9%) had HGSIL, 10 (4.0%) had ASCUS and 11 (4.4%) had Pap
smears that could not be classified. In total 47.2% of the Pap smears were abnormal. There was
one case of malignancy developing after an abnormal Pap smear. Patients with abnormal Pap
smears tended to have a lower mean CD4 cell count while the viral load and WHO Stage did not
appear to have an impact on the final analysis of the Pap smears.
Conclusion
The rates of cervical abnormality in HIV sero-positive patients attending the Johannesburg
Hospital postnatal clinic are much higher (47.2%) than would be expected in the general
population (10%), with a significant portion requiring follow-up investigation and management.
It is however preferable to deal with cervical cytological abnormalities comprehensively during
the screening phase rather than trying to manage a potential increase in cervical cancer cases.
Description
MMed(Obstetrics and Gynaecology)
Keywords
cervical smears, HIV positive women, postnatal women