HPV Type Distribution and Cervical Cytology among HIV-Positive Tanzanian and South African Women

Abstract

Background. There are limited data on high-risk human papillomavirus (hr-HPV) genotypes among HIV-positive women in Africa, and little is known about their relationship with cervical cytology in these populations. Methods. We conducted a cross-sectional study among 194 HIV-positive women (143 from Tanzania, and 51 from South Africa) to evaluate HPV genotypes among HIV-positive women with normal and abnormal cytology. Cervical samples were genotyped for HPV types, and slides were evaluated for atypical squamous cell changes according to the Bethesda classification system. Results. Prevalence of high grade squamous intraepithelial dysplasia (HSIL) was 9%. Overall, more than half (56%) of women were infected with an hr-HPV type; 94% of women with HSIL (n = 16), 90% of women with LSIL (n = 35), and 42% of women within normal limits (WNL) (n = 58) tested positive for hr-HPV. Overall, the most prevalent hr-HPV subtypes were HPV16 (26%) and HPV52 (30%). Regional differences in the prevalence of HPV18 and HPV35 were found. Conclusion. Regional differences in HPV genotypes among African women warrant the need to consider different monitoring programmes for cervical preneoplasia. HPV-based screening tests for cervical preneoplasia would be highly inefficient unless coupled with cytology screening of the HPV-positive sample, especially in HIV-positive women.

Figure 1

(a) LSIL, with polyploid (enlarged) nuclei and koilocytosis. Tested positive for hr-HPV 52 and hr-HPV 56. (b) HSIL, dyskeratotic cells. Tested positive for lr-HPV 44, hr-HPV 52, and undetermined HPV types.

Figure 2

(a) Age distribution versus hr-HPV genotypes. (b) Age distribution versus lr-HPV genotypes.

Figure 3

(a) Percentage weighted prevalence with country specific hr-HPV prevalence is shown. Significant differences between Tanzania and South Africa are marked with an asterisk if P < 0.05. (b) Percentage weighted prevalence with country specific lr-HPV prevalence is shown.