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. 2023 Mar 15;37(4):625-635.
doi: 10.1097/QAD.0000000000003437. Epub 2022 Dec 1.

High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa

Mkunde Chachage  1   2   3 , Ajay P Parikh  4   5 , Anifrid Mahenge  1 , Emmanuel Bahemana  4   6 , Jonathan Mnkai  1 , Wilbert Mbuya  1 , Ruby Mcharo  1 , Lucas Maganga  1 , Jaqueline Mwamwaja  1 , Reginald Gervas  4   6 , Hannah Kibuuka  7 , Jonah Maswai  4   8 , Valentine Singoei  9   10 , Michael Iroezindu  4   11 , Abiola Fasina  4   11 , Allahna Esber  4   5 , Nicole Dear  4   5 , Michelle Imbach  4   5 , Trevor A Crowell  4   5 , Jaclyn Hern  4   5 , Xiaofang Song  4   5 , Michael Hoelscher  3   12 , Christina S Polyak  4   5 , Julie A Ake  4 , Christof Geldmacher  3   12 ; AFRICOS Study Group
Affiliations

High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa

Mkunde Chachage et al. AIDS. .

Abstract

Objective: Cervical cancer is a common preventable cancer among African women living with HIV (WLWH). Molecular diagnostics for high-risk human papillomavirus (HR-HPV) genotypes are standard components of cervical cancer screening in resource-rich countries but not in resource-limited settings. We evaluated HR-HPV genotypes among women with and without HIV in four African countries to inform cervical cancer preventive strategies.

Methods: The African Cohort Study (AFRICOS) enrolled participants with and without HIV at 12 clinics in Tanzania, Kenya, Uganda, and Nigeria. Cervical cytobrush specimens from women were genotyped for 14 HR-HPV types using the multiplex Seegene Anyplex real-time PCR assay. Robust Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with HR-HPV in WLWH.

Results: From January 2015 to March 2020, 868 WLWH and 134 women living without HIV (WLWoH) were tested for HR-HPV with prevalence of 50.9 and 38.1%, respectively ( P = 0.007). Among WLWH, 844 (97.4%) were antiretroviral therapy (ART)-experienced and 772 (89.7%) virally suppressed 1000 copies/ml or less. The most frequent HR-HPV types among WLWH were HPV-16 (13.5%), HPV-52 (9.5%), and HPV-35 (9.3%). HR-HPV infection was more common among Tanzanian WLWH (adjusted RR: 1.23, 95% CI 1.05-1.44, P = 0.012). Also, WLWH with CD4 + T cells of less than 200 cell/μl had 1.51-fold increased risk of having HR-HPV (95% CI 1.23-1.86, P < 0.001).

Conclusion: HR-HPV was common in WLWH in four African countries, particularly among women with low CD4 + cell count. Scale up of HPV vaccines and development of vaccines with broader activity against less common HR-HPV types may improve cervical cancer prevention in Africa.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Distribution of high-risk human papilloma virus genotypes in women living with HIV and women living without HIV in the African Cohort Study.
Fig. 2
Fig. 2
Prevalence of multiple high-risk human papilloma virus infections in women living with HIV and women living without HIV with high-risk human papilloma virus infections in the African Cohort Study.
Fig. 3
Fig. 3
Distribution of high-risk human papilloma virus genotypes in women living with HIV in the African Cohort Study stratified by HIV-related parameters.
Fig. 4
Fig. 4
Factors associated with high-risk human papilloma virus among women living with HIV in the the African Cohort Study.
See this image and copyright information in PMC

References

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Publication types

Supplementary concepts