Evidence for the association between Human immunodeficiency virus
infection and
cervical cancer has been contrasting, with some studies reporting increased risk of
cervical cancer among HIV positive women while others report no association. Similar evidence from Tanzania is scarce as HIV seroprevalence among
cervical cancer patients has not been rigorously evaluated. The purpose of this study was to determine the association between HIV and
tumor differentiation among patients with
cervical cancer at Bugando Medical Centre and Teaching Hospital in Mwanza, North-Western Tanzania.
METHODS: A total of 91 suspected
cervical cancer patients were seen during the study period and 74 patients were histologically confirmed with
cervical cancer. The mean age of those confirmed of
cervical cancer was 50.5 ± 12.5 years. Most patients (39 of the total 74-52.7%) were in early disease stages (stages IA-IIA).
HIV infection was diagnosed in 22 (29.7%) patients. On average, HIV positive women with early
cervical cancer disease had significantly more CD4+ cells than those with advanced disease (385.8 ± 170.4 95% CI 354.8-516.7 and 266.2 ± 87.5, 95% CI 213.3-319.0 respectively p = 0.042). In a binary logistic regression model, factors associated with
HIV seropositivity were ever use of
hormonal contraception (OR 5.79 95% CI 1.99-16.83 p = 0.001), aged over 50 years (OR 0.09 95% CI 0.02-0.36 p = 0.001), previous history of
STI (OR 3.43 95% CI 1.10-10.80 p = 0.035) and multiple sexual partners OR 5.56 95% CI 1.18-26.25 p = 0.030). Of these factors, only ever use of
hormonal contraception was associated with
tumor cell differentiation (OR 0.16 95% CI 0.06-0.49 p = 0.001).
HIV seropositivity was weakly associated with
tumor cell differentiation in an unadjusted analysis (OR 0.21 95% CI 0.04-1.02 p = 0.053), but strong evidence for the association was found after adjusting for ever use of
hormonal contraception with approximately six times more likelihood of
HIV infection among women with poorly differentiated
tumor cells compared to those with moderately and well differentiated cells (OR 5.62 95% CI 1.76-17.94 p = 0.004).
CONCLUSION: Results from this study setting suggest that HIV is common among
cervical cancer patients and that
HIV seropositivity may be associated with poor tumour differentiation. Larger studies in this and similar settings with high HIV prevalence and high burden of
cervical cancer are required to document this relationship.