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 journalArticlepeer-review

3 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 languageEnglish
Pages (from-to)625-635
Number of pages11
JournalAIDS
Volume37
Issue number4
DOIs
StatePublished - 15 Mar 2023
Externally publishedYes

Keywords

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

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