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

Mkunde Chachage; Ajay P. Parikh; Anifrid Mahenge; Emmanuel Bahemana; Jonathan Mnkai; Wilbert Mbuya; Ruby Mcharo; Lucas Maganga; Jaqueline Mwamwaja; Reginald Gervas; Hannah Kibuuka; Jonah Maswai; Valentine Singoei; Michael Iroezindu; Abiola Fasina; Allahna Esber; Nicole Dear; Michelle Imbach; Trevor A. Crowell; Jaclyn Hern; Xiaofang Song; Michael Hoelscher; Christina S. Polyak; Julie A. Ake; Christof Geldmacher

doi:10.1097/QAD.0000000000003437

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

Mkunde Chachage^*, Ajay P. Parikh, Anifrid Mahenge, Emmanuel Bahemana, Jonathan Mnkai, Wilbert Mbuya, Ruby Mcharo, Lucas Maganga, Jaqueline Mwamwaja, Reginald Gervas, Hannah Kibuuka, Jonah Maswai, Valentine Singoei, Michael Iroezindu, Abiola Fasina, Allahna Esber, Nicole Dear, Michelle Imbach, Trevor A. Crowell, Jaclyn HernXiaofang Song, Michael Hoelscher, Christina S. Polyak, Julie A. Ake, Christof Geldmacher

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

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.

Original language	English
Pages (from-to)	625-635
Number of pages	11
Journal	AIDS
Volume	37
Issue number	4
DOIs	https://doi.org/10.1097/QAD.0000000000003437
State	Published - 15 Mar 2023
Externally published	Yes

Keywords

AIDS
Africa
HIV
antiretroviral therapy
high-risk human papilloma virus
uterine cervical neoplasms
women living with HIV

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10.1097/QAD.0000000000003437

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Chachage, M., Parikh, A. P., Mahenge, A., Bahemana, E., Mnkai, J., Mbuya, W., Mcharo, R., Maganga, L., Mwamwaja, J., Gervas, R., Kibuuka, H., Maswai, J., Singoei, V., Iroezindu, M., Fasina, A., Esber, A., Dear, N., Imbach, M., Crowell, T. A., ... Geldmacher, C. (2023). High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa. AIDS, 37(4), 625-635. https://doi.org/10.1097/QAD.0000000000003437

@article{d5d359f21521460a8e9d2dc6f7131e17,

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

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.",

keywords = "AIDS, Africa, HIV, antiretroviral therapy, high-risk human papilloma virus, uterine cervical neoplasms, women living with HIV",

author = "Mkunde Chachage and Parikh, {Ajay P.} and Anifrid Mahenge and Emmanuel Bahemana and Jonathan Mnkai and Wilbert Mbuya and Ruby Mcharo and Lucas Maganga and Jaqueline Mwamwaja and Reginald Gervas and Hannah Kibuuka and Jonah Maswai and Valentine Singoei and Michael Iroezindu and Abiola Fasina and Allahna Esber and Nicole Dear and Michelle Imbach and Crowell, {Trevor A.} and Jaclyn Hern and Xiaofang Song and Michael Hoelscher and Polyak, {Christina S.} and Ake, {Julie A.} and Christof Geldmacher",

year = "2023",

month = mar,

day = "15",

doi = "10.1097/QAD.0000000000003437",

language = "English",

volume = "37",

pages = "625--635",

journal = "AIDS",

issn = "0269-9370",

number = "4",

}

Chachage, M, Parikh, AP, Mahenge, A, Bahemana, E, Mnkai, J, Mbuya, W, Mcharo, R, Maganga, L, Mwamwaja, J, Gervas, R, Kibuuka, H, Maswai, J, Singoei, V, Iroezindu, M, Fasina, A, Esber, A, Dear, N, Imbach, M, Crowell, TA, Hern, J, Song, X, Hoelscher, M, Polyak, CS, Ake, JA & Geldmacher, C 2023, 'High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa', AIDS, vol. 37, no. 4, pp. 625-635. https://doi.org/10.1097/QAD.0000000000003437

TY - JOUR

T1 - High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa

AU - Chachage, Mkunde

AU - Parikh, Ajay P.

AU - Mahenge, Anifrid

AU - Bahemana, Emmanuel

AU - Mnkai, Jonathan

AU - Mbuya, Wilbert

AU - Mcharo, Ruby

AU - Maganga, Lucas

AU - Mwamwaja, Jaqueline

AU - Gervas, Reginald

AU - Kibuuka, Hannah

AU - Maswai, Jonah

AU - Singoei, Valentine

AU - Iroezindu, Michael

AU - Fasina, Abiola

AU - Esber, Allahna

AU - Dear, Nicole

AU - Imbach, Michelle

AU - Crowell, Trevor A.

AU - Hern, Jaclyn

AU - Song, Xiaofang

AU - Hoelscher, Michael

AU - Polyak, Christina S.

AU - Ake, Julie A.

AU - Geldmacher, Christof

PY - 2023/3/15

Y1 - 2023/3/15

N2 - 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.

AB - 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.

KW - AIDS

KW - Africa

KW - HIV

KW - antiretroviral therapy

KW - high-risk human papilloma virus

KW - uterine cervical neoplasms

KW - women living with HIV

UR - http://www.scopus.com/inward/record.url?scp=85148678916&partnerID=8YFLogxK

U2 - 10.1097/QAD.0000000000003437

DO - 10.1097/QAD.0000000000003437

M3 - Article

C2 - 36398743

AN - SCOPUS:85148678916

SN - 0269-9370

VL - 37

SP - 625

EP - 635

JO - AIDS

JF - AIDS

IS - 4

ER -

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

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Keywords

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