Inflammatory cytokine responses in women with HIV, HPV and Cervical dysplasia at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background Cervical cancer is the second commonest cancers among women and is caused by Human Papillomavirus (HPV). HIV+ women are at a higher risk of acquiring HPV increasing their odds of developing pre-cervical cancer lesions (dysplasia) and cervical cancer. In HPV infection and cervical dysplasia there is increased production of inflammatory cytokines. Early diagnosis remains key in prevention of cervical cancer but reduced sensitivities and specificities of available screening methods pose challenges. Interrogating alternative approaches to improve diagnosis is important. Screening women for inflammatory cytokines and comparing it with HIV, HPV and cervical dysplasia has potential diagnostic value. Broad Objective To compare inflammatory cytokine responses in women with HIV, HPV and cervical dysplasia. Methodology This was a cross sectional study design targeting women above 18 years attending cervical cancers screening clinics at AMPATH. Stratified sampling technique was employed to select HIV positive and negative respondents. A sample size of 88 was determined using a formula for calculating difference in proportions in two populations. Cervicovaginal lavage samples were collected from women. This was assayed for inflammatory cytokines using flow cytometry (bead assay) and Human papillomavirus (HPV) using hybrid capture technique. Cervical dysplasia was determined by doing Visual inspection with acetic acid (VIA). Ethical approval was obtained from IREC. Analysis was done using student t-test, chi square and Mann Whitney U test. P values < 0.05 were considered significant. Results The mean age of participants was 37.4 years. A significantly higher proportion of HIV- women were married. HIV+ women also had significantly higher number of sexual partners. There was no difference in levels of inflammatory cytokine levels between HIV+ and HIV- women. Interleukin (IL) 1 and IL8 were significantly higher in HPV+ women. IL1 and IL8 were also significantly higher in women with dysplasia (VIA+). The prevalence of HPV was 59.1% in HIV+ women and 43.2% in HIV- women. Study Limitations: The study was limited by lack of correction for dilution effect in CVL and the determination of HIV negativity status by self- reporting. Other genital tract infections were not ruled out. Conclusion and Recommendations HIV+ women have similar inflammatory cytokine responses to HIV- women. There is relative higher production of inflammatory cytokines IL1 and IL8 in women with dysplasia (VIA+), and women infected with HPV compared to their respective negative counterparts. Further investigation on the relationship between IL1; IL8 and VIA is needed and the potential of utilizing these cytokines in cervical cancer diagnosis should be explored.