Clinicopathologic findings of cervical cancer among HIV negative and positive patients seen at Moi Teaching and Referral Hospital

Abstract

Background: Cervical cancer is the third most common cancer in women worldwide with an estimated 530,000 new cases in 2008. In Kenya, it is the second most frequent cancer among women with an annual incidence of 2454 cases. It is the leading cause of cancer mortality in Kenyan women. At least 177 newly diagnosed cervical cancer patients were seen at Gyn-oncology clinic of MTRH in the year 2014. About 16.7 million women are living with HIV globally. In Kenya, the HIV/AIDs prevalence among women aged 15-64 years is 6.9%. The emergence of HIV/AIDS has altered the clinical features of cervical cancer and its effect on cervical cancer presentation is not well known in western Kenya. Objective: To determine the difference in clinical stages and histological findings of cervical cancer between HIV positive and HIV negative patients seen at MTRH gynooncology clinic. Methodology:This was a cross-sectional descriptive study conducted between February and August 2014 that involved clinical and histological examination of cervical cancer among 40 HIV positive and 40 HIV negative patients.Consecutive sampling was used to recruit histologically confirmed cervical cancer patients into each arm of the study. Structured interviewer administered questionnaires were administered to eligible participants to collect information on patient’s biodata, clinical presentation and risk factor profile. Data on FIGO stage of cervical cancer, Histological type and degree of differentiation were obtained from the patient’s file. Data was analyzed using SAS version 9.3. Results: Cervical cancer presented 7 years earlier among the HIV positive patients 40(IQR: 34-46) years vs 47(IQR:40-55), P=0.0002. Overall, 52% of the patients presented with early cancer (FIGO stage I-IIA). About 25(63%) of HIV positive patients presented with early cancer as compared to 17(43%) of the HIV negative patients. Of the HIV positive patients, majority (48%) were in FIGO stage I; stages II, III and IVA comprised 12(30%), 8(20%) and 1(2.5%) respectively. Majority of the HIV negative patients, 16(40%) were in FIGO stage III; stages I, II and IVA comprised 11(27.5%), 12(30%), 1(2.5%) respectively. Squamous cell carcinoma was the predominant histological type 74(92.5%) for both groups, with 3 (3.8%) patients presenting with adenocarcinoma. Equal number of patients in both groups had well differentiated tumors 29%; of the HIV positive patients moderately differentiated tumors and poorly differentiated tumors accounted for 35% each while of the HIV negative patients 10(41.7%) and 7(29.2%) had moderately and poorly differentiated tumors.There was no statistically significant difference in the FIGO stage, histological type and the degree of differentiation of cervical cancer between the HIV positive and negative patient (p=0.073, p=1.000 and p=0.895 respectively). The commonest presenting symptoms were abnormal vaginal bleeding 53(66.3%) and abnormal vaginal discharge 16(20%) regardless of the HIV status. Conclusion: HIV positive patients with cervical cancer were 7 years younger than the HIV negative patients. There was no significant difference in the FIGO stages, histological types and degree of differentiation of cervical cancer between the HIV negative and positive women. Recommendations: A Cohort study should be conducted to establish the effect of HIV and HAART on the progression of cervical cancer in western Kenya.