Cervical human papillomavirus and HIV infection in women of child-bearing age in Abidjan, Côte d'Ivoire, 2010

Abstract

Background: We sought to document the association of Human immunodeficiency Virus (HIV) infection and immunodeficiency with oncogenic Human Papillomavirus (HPV) infection in women with no cervical neoplastic lesions identified through a cervical cancer screening programme in Côte d'Ivoire.

Methods: A consecutive sample of women stratified on their HIV status and attending the national blood donor clinic or the closest HIV clinic was recruited during a cervical cancer screening programme based on the visual inspection. Diagnosis of HPV infection and genotype identification were based on the Linear Array; HPV test.

Results: A total of 445 (254 HIV-positive and 191 HIV-negative) women were included. The prevalence of oncogenic HPV infection was 53.9% (95% confidence interval (CI) 47.9-59.9) in HIV-positive women and 33.7% (95% CI 27.1-40.3) in HIV-negative women (odds ratio (OR)=2.3 (95% CI 1.5-3.3)). In multivariate analysis, HIV-positive women with a CD4 count <200 cells mm(3) or between 200 and 499 cells mm(3) were more likely to harbour an oncogenic HPV compared with women with a CD4 count ≥500 cells mm(3) with OR of 2.8 (95% CI 1.1-8.1) and 1.7 (95% CI 1.0-2.9), respectively.

Conclusion: A high prevalence of oncogenic HPV was found in women with no cervical neoplastic lesions, especially in HIV-positive women. Despite antiretroviral use, immunodeficiency was a main determinant of the presence of oncogenic HPV.

Figure 1

Distribution of HPV genotypes according to HIV status among women with no cervical neoplastic disease in Abidjan, Côte d’Ivoire (n=445). International epidemiological Database to Evaluate AIDS West Africa collaboration 2010. *HPV 52 present without any co-infection HPV 33, 35 or 58, the probe for detection of HPV 52 cross reacts with HPV 33, 35 and 58. In case of infection with HPV 33, 35 and/or 58, the presence of HPV 52 cannot be proved. ^†Defined as carcinogenic (group 1: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59) or probably carcinogenic to humans (group 2A: 68) according to IARC monographs. ^‡According to IARC monographs.

Figure 2

HPV distribution according to age classes in HIV-positive (n=254) and HIV-negative women (n=191) with no cervical neoplastic disease in Abidjan, Côte d’Ivoire. International epidemiological Database to Evaluate AIDS West Africa collaboration 2010. * Defined as carcinogenic (group 1: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59) or probably carcinogenic to humans (group 2A: 68) according to IARC monographs. ^†Defined as possibly carcinogenic to humans (Group 2B), not classifiable as to their carcinogenicity to humans (Group 3) or unspecified carcinogenicity according to IARC monographs.