Screening of Gynaecological Surgical Patients for HIV-1 Infection in Nigeria (Pages 59-66)

Nosakhare O. Enaruna1, Joseph U. Onakewhor1, Abieyuwa P. Osemwenkha1, Adesuwa N. Olu-Eddo2, Wilson O. Akhiwu2 and Olayemi Matthew3 and M. Charurat4

1Department of Obstetrics and Gynaecology,University of Benin Teaching Hospital, Benin City, Nigeria; 2Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria; 3Institute of Human Virology Nigeria, Abuja, Nigeria; 4Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA


Abstract: Background: HIV infection in gynaecological surgical diseases (GSDs) is associated with higher complications but epidemiological data in Nigeria is scarce.

Objective: To determine the proportion, pattern and factors associated with HIV-1 infections among GSDs patients and early linkage to HIV care and treatment.

Materials and Method: This one-year prospective study enrolled consecutive volunteers admitted January 1 through December 31, 2007 for gynaecological surgeries in a tertiary Nigerian hospital. The women were pre- and post-test counselled and screened for HIV-1 antibodies using Abbott Determine for HIV- 1 and 2 (Abbott Laboratories, Illinois, USA) and Uni-Gold Recombigen HIV (Trinity Biotech, Wicklow, Ireland) in a serial test algorithm. Repeatedly reactive samples were considered positive. Discordant results were confirmed using HIV-1/2 Stat-Pak (Chembio, Medford, NY) as tie-breaker.The patients’ socio-demographic characteristics and associated factors were obtained using structured questionnaire. Seropositive women were linked to care. The outcome measures were proportion of women with HIV positive results, associated factors and mortality rate over a one year follow up period.

Results: The overall proportion of HIV positive result was 6.3% (26/413) with women aged ≥ 45 years having the highest proportion (8.45%). Only 9.4 % (39/413) were aware of their HIV status prior to testing. Of the HIV positive patients, 7.7% (2/26) knew their status and were on antiretroviral drugs. They had not been sexually active in the last six months. Multiple sexual partners (p<0.000), STIs (p<0.000), traditional medications (p<0.003), pelvic abscess (p=0.008), cervical cancer (p<0.003), induced abortions (p<0.001) were HIV-associated factors. Previous blood transfusion, surgeries, benign tumors, non-cervical gynaecological malignancies were not. There were no mortalities over a one year follow up period.

Conclusion: The proportion of HIV infection among women admitted for GSDs was high but prior knowledge of HIV status was low. The study has provided a window of opportunity for screening, diagnosis and early treatment. Integration of HIV counselling and testing into gynecological services would be desirable.

Keywords: HIV, Gynaecological Diseases, Surgery, Linkage, Care, Associated Factors.