Background HIV infected women have an increased risk of acquiring genital tract infections and progression of pre-malignant cervical lesions. We describe the prevalence and incidence of genital tract abnormalities in TB-HIV co-infected women initiating ART(Antiretroviral therapy).

Methods We conducted a retrospective study among 750 ambulant TB-HIV co-infected women initiating ART in Durban, between 2004 and 2011. All patients received sexual reproductive health services including a Papanicolaou (Pap) smear examination; and screening; diagnosis and management of sexually transmitted infections (STIs). Pap smear reporting included the Bethesda classification for endocervical abnormalities, and STI screening for Human papilloma virus (HPV), trichomonas vaginalis, bacterial vaginosis (BV) and candidiasis.

Results Baseline pap smears were obtained before or up to 6 months post-ART initiation in 750 women; mean (standard deviation(SD)) age 34.2 (8.0) years; mean CD4+ count 181.4 (SD 178.5) cells/mm3 and median log viral load 4.4 (IQR 2.6) copies/ml. Prevalence of genital tract abnormalities was 58.5% (439/750); comprising18.0%(135/750) cervical lesions only, 11.7% (88/750) STI’s only and 28.8% (216/750) both STI’s and endocervical lesions. No abnormalities were detected in 19.9% of women (149/750), while results from 21.6%(162/750) were missing. STI prevalence was 40.5% (304/750); comprising HPV 20.0%(150/750), candidiasis 16.1%(121/750), BV7.9%(59/750), trichomonas vaginalis in 5.5%(41/750).Prevalence of endocervical abnormalities was 46.8%(351/750); comprising Atypical Squamous Cells of Unknown Significance (ASCUS) 10.1%(76/750); Cervical Carcinoma (CACX) 0.5%(4/750) and High(HGSIL) and Low (LGSIL) Grade Squamous Intra-epithelial Lesions of 12.1%(91/750) and 24.0%(180/750), respectively. The incidence HPV in this cohort was 24.8 per 100 women years (95% CI: 15.7 to 37.2), incidence of ASCUS 7.8, HGSIL 11.1, LSIL 25.9, and CACX 0 per 100 women years, respectively. HPV was present in 19.2% of LSIL, 0.4% of HGSIL, 0.1% of patients with ASCUS and CACX.

Conclusion HPV infections and LGSIL were the dominant genital tract abnormalities in TB-HIV co-infected patients accessing ART.