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pubmed:otherAbstract |
PIP: Women attending 2 family planning clinics in Nairobi, Kenya, were enrolled in a study of risk factors for HIV infection between October 1989 and May 1991. Data were obtained using a structured questionnaire on social, demographic, medical, and sexual behavior. During pelvic examination, were obtained specimens, for a Papanicolaou (PAP) smear and for sexually transmitted disease (STDs). 4058 women had an interpretable smear (with both squamous and endocervical cells present). 82 of the 4058 (women 2.0% had cytological evidence of cervical intraepithelial neoplasia (CIN): 58 had CIN-I, 23 had CIN 11, and 1 had CIN III. Single women were at a reduced ask for CIN (multivariate odds ratio = OR, 0.25; 95% confidence interval = CI, 0.07-0.86). There was no consistent association between number of pregnancies and CIN, although there was some evidence of a protective effect of later age at first pregnancy (P for linear trend = 0.07 and 0.35 in the crude and multivariate analyses, respectively). Age at first intercourse of at least 19 years compared with an age of 16 years of under was protective against CIN (OR, 0.45; 95% CI, 0.20-0.97). Having more than one lifetime sex partner increased the risk of CIN (OR, 1.60; 95% CI, 0.86-2.99). Positive syphilis serology was associated with a doubling of risk (OR, 2.28; 95% CI, 0.6%-7.63). Oral, intrauterine, or injectable contraception was not significantly associated with CIN. Ten (4.9%) of the 205 HIV-seropositive women had CIN, compared with 72 (1.9%) of the 3853 HIV-seronegative women (OR, 2.69; 95% CI, 1.29-5.49). This positive association remained after controlling for sexual behavior and other risk factors. On clinical examination, enlarged cervical, axillary, or inguinal lymph nodes were detected in 5.1% of the HIV-seropositive women compared with 1.7% of the HIV-seronegative women. CIN was more common among 204 HIV-seropositive women with symptoms or signs consistent with immunodeficiency (weight loss, fever, diarrhea); however, none of these associations reached statistical significance.
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