2 HIV-positive women have a higher prevalence and in- cidence of cervical precancerous lesions than HIV negative women. HIV-positive women have a 2-fold to 4-fold greater rate of HPV infection than HIV-negative women. The prev- alence of HPV among HIV-positive women is associated strongly with CD4 counts and HIV viral load (VL) [10, 11]. Highly active antiretroviral therapy (HAART) has been shown to decrease HIV viral loads, increase CD4 cell counts, and decrease most opportunistic infections. Since the introduction of HAART there has been a decline in certain malignancies in HIV-infected individuals [12, 13]. However, studies on the impact of HAART on the natural history of cervical squamous intraepithelial lesions (SILs) have produced inconsistent results [14, 15]. In HIV-infected women, there is an increased risk of HPV infection and squamous intraepithelial lesions (SIL), the precursor of cervical cancer [16, 17]. There is still limited evidence for understanding the natural history and epidemiology of HPV- induced cervical cancer in HIV-infected women. Therefore this study may assist policy makers to develop guidelines for prevention and treatment strategies for cervical cancer among HIV-infected women which is largely based on limited evidence, or in the case of resource limited settings, which currently are completely lacking. The objective of the study was to assess prevalence and associated risk factors for precancerous cervical lesions in HIV-infected women within resource-limited settings in Kenya. 2. Methods The study site was a faith-based hospital oﬀering compre- hensive care and treatment to approximately 4,000 HIV- infected patients. The study site was located in Central Kenya, Kiambu district which has a HIV prevalence of 4%. The study population constituted eligible women attending the ART treatment clinics. None of the patients had evidence of Kaposi sarcoma or non-Hodgkin lymphoma. Eligibility criteria included being aged 18–69 years and having no current or past history of cervical disease. Women, eighteen years and older, who were on followup for their HIV-positive status, were screened for cervical cancer using the Visual Inspection with Lugol’s Iodine (VILI) technique. Data on sociodemographic status, sexual behavior, his- tory of a sexually transmitted infection (STI), obstetrics, and gynecology history (parity) was obtained from patient medical records as part of the routine quality improvement activities; CD4 count data and HAART status were also extracted from clinical records. Clients were referred to the clinician where a pelvic examination was conducted using a sterile speculum examination. Visual inspection with lugol’s iodine (VILI) was used as the screening technique. A positive VILI test necessitated a cervical biopsy; this was preserved in a sterile container using formalin as the ﬁxative and the biopsies were then taken for histology. The histology result upon biopsy would turn out to be either negative for intraepithelial lesion (IEL), active/chronic cervicitis, precancerous lesions (CIN I, CIN II, or CIN III/CIS), or cervical cancer (squamous cell or adenocarci- noma) which was either diﬀerentiated (well, moderately, AIDS Research and Treatment poorly diﬀerentiated) cervical cancer. The cervical cancer clients were clinically staged using the 1986 International Federation of Gynecology and Obstetrics (FIGO) architec- tural staging system [18]. Their participation in the screening in no way aﬀected access to, or provision of, comprehensive HIV/AIDS care as this was a standard of care at the clinic. 2.1. Statistical Analysis. Statistical analysis was carried out using STATA 11 (StataCorp LP, College Station, TX, USA). Descriptive statistics (medians and proportions) were used to characterize the variables. Bivariate (unadjusted) analysis was performed to identify factors signiﬁcantly associated with the precancerous lesions. Odds ratios (OR), 95% conﬁ- dence intervals (CI) and two-tailed P values were calculated. Statistical tests used were the Chi-square and Fischer’s exact tests for proportions, median test, and Wilcoxon rank test for continuous variables. Variables found to be statistically signiﬁcant (P < 0.05) on unadjusted analysis were included in a multivariate logistic regression model through a combination of forward and backward stepwise methods. 3. Result 3.1. Sociodemographic Characteristics of the Study Partici- pants. All the 715 HIV-positive women attending the clinic between June 2009 and December 2010 were included for this study. The median age of the participants was 40 years (range 18–69 years). About 589 (85.5%) were in the reproductive age group (15–49) years. Regarding the parity, 555 (94%) have ≥1 child. About 645 (90.3%) were ever married and 53 (7.4%) were single (Table 1). 3.2. Clinical and Reproductive Characteristics. The majority of participants were in WHO stage III 316 (44%) and 210 (29.2%) in WHO stage IV (Table 1). Concerning the baseline CD4 count, 273 (97.5%) ART clients and 7 (2.5%) preART cases were below 200/mm3 while 245 (71.9%) ART and 96 (28.1%) of Pre-aRT cases were above 200/mm3. About 90 (91.8%) Pre-ART and 8 (8.2%) ART of the study cases were below 200 in their current CD4 count and 488 (82.9%) ART and 100 (17.1%) Pre-ART cases were ≥200 in their current CD4 (Table 2). The median and mean baseline CD4 cell count were 228.0/mm3 and 251/mm3 (range 1– 1547.0/mm3). The median and mean current CD4 cell count were 438.0/mm3 and 458/mm3 (range 5–1547.0/mm3). About 578 (84.3%) women with HIV infection were on antiretroviral therapy (ART). About 642 (92.6%) of the HIV-infected women were in followup period of ≥1 year. About 610 (85.4%) of the participants did not have any history of abortion and 104 (14.6%) had history of abortion at least once in life time. The prevalence of precancerous lesions (CIN I, CIN II, CIN III, and ICC) was 191 (26.7%) (Table 1). 3.3. Factors Associated with Precancerous Cervical Cancer Lesions in HIV-Infected Women. In the bivariate analysis (Table 3), only two variables are found to be associated