AIDS Research and Treatment Characteristics Current CD4 count <200 ≥200 Yes No On HAART Negative 78 (72.2) 431 (87.5) 91 (84.2) 404 (69.8) Positive 30 (27.8) 147 (81.3) 17 (15.8) 174 (30.2) Table 3: Unadjusted and adjusted odds ratios of the multilevel logistic regression estimates for factors associated with precancerous cervical cancer lesions among HIV+ at Nazareth Hospital. Cervical cancer screening Unadjusted/cOR Adjusted/aOR P value P value 0.038 0.003 1.61 (1.02–2.53) 1.00 1.00 2.23 (1.29–3.86) 1.00 2.21 (1.28–3.83) 0.005 5 [21, 50]. Starting HAART has an impact on reducing the incidence and progression and facilitating the regression of CIN infection and cervical abnormalities. The study should be interpreted in light of the strength and limitations. Major strengths of our study include the large number of women, high participation, and reliance on cost-eﬀective, simple, timely VILI testing. The Limitations include but not limited to the lack of information on some of the variables that can predict cervical cancer in HIV-infected women like the use of oral contraceptives or estrogens, information on sexual behavior, and smoking [49] and the cross-sectional nature of this study allows the possibility for confounding so it is diﬃcult to reach any causality. This may hence hinder the generalizability of our ﬁndings. 5. Conclusion In this study, the prevalence of CIN was 26.7 percent (191) which is lower than other ﬁndings reported in Africa. Those patients who were not on antiretroviral therapy were more likely to have CIN diagnosis than who were on antiretroviral therapy. Therefore regular screening of HIV-infected women is of paramount importance. Starting ART acts as leverage for cancer screening and majority of ART patients are likely not to progress to cervical cancer as demonstrated by this study. Conducting well-designed prospective cohort study to study natural history of cervical neoplasia among HIV- infected women in developing country settings is warranted. Conﬂict of Interests All authors declare that they have no conﬂict of interests associated with the publication of this paper. Authors’ Contribution W. Mbuthia, F. Odhiambo, G. Kiiru, S. Ojoo, and S. Agbor assisted in the collection of data and technical aspects of the paper. P. Memiah Conceived and designed the study and collected data in the ﬁeld, performed analysis, interpretation of data, and critical review of the paper. W. Mbuthia, F. Odhiambo, P. Memiah participated in design and helped to draft the paper. S. Biadgilign assisted with the design, interpretation of data, draft, and critical review of the paper. All authors approved and read the ﬁnal paper. All authors participated in critical appraisal of the paper. Acknowledgments This study was funded by Norfolk Church US and supported within AIDS Relief PEPFAR initiatives. References [1] D. M. Parkin, F. Bray, J. Ferlay, and P. Pisani, “Global cancer statistics, 2002,” Ca-A Cancer Journal for Clinicians, vol. 55, no. 2, pp. 74–108, 2005. [2] Centers for Disease Control and Prevention, “MMWR. Rec- ommendations and Reports-1993 Revised classiﬁcation sys- tem for HIV infection and expanded surveillance case def- inition for AIDS among adolescents and adults,” Jan- uary 2011, http://www.cdc.gov/mmwr/preview/mmwrhtml/ 00018871.htm. [3] International AIDS Vaccine Initiative & PATH, “HPV Vaccine Adoption in Developing Countries: Cost and Financing Issues,” 2007, http://www.iavi.org/, http://www.path.org/pub- lications/. [4] World Health Organization, “Control of cancer of the cervix uteri: review article based on a report of a WHO meeting, November 1985, Geneva,” Bulletin of the World Health Orga- nization, vol. 64, pp. 607–618, 1986. [5] J. C. Johnson, A. F. Burnett, G. D. Willet, M. A. Young, and J. Doniger, “High frequency of latent and clinical human papillomavirus cervical infections in immunocompromised human immunodeﬁciency virus-infected women,” Obstetrics and Gynecology, vol. 79, no. 3, pp. 321–327, 1992. [6] S. H. Vermund and K. F. Kelley, “Human papillomavirus in women: methodologic issues and role of immunosuppres- sion,” in Reproductive and Perinatal Epidemiology, M. Kiely, Ed., pp. 143–168, CRC Press, Boca Raton, Fla, USA, 1991. [7] A. R. Feingold, S. H. Vermund, R. D. Burk et al., “Cer- vical cytologic abnormalities and papillomavirus in women infected with human immunodeﬁciency virus,” Journal of Acquired Immune Deﬁciency Syndromes, vol. 3, no. 9, pp. 896– 903, 1990. [8] S. H. Vermund, K. F. Kelley, R. S. Klein et al., “High risk of human papillomavirus infection and cervical squamous intraepithelial lesions among women with symptomatic human immunodeﬁciency virus infection,” American Journal of Obstetrics and Gynecology, vol. 165, no. 2, pp. 392–400, 1991.