Cervical human papillomavirus prevalence, risk factors and outcomes in a cohort of HIV-infected women in Harare, Zimbabwe.

Mandiriri, Ardele M; Pascoe, Margaret J; Shamu, Tinei; Lowe, Sara (2020). Cervical human papillomavirus prevalence, risk factors and outcomes in a cohort of HIV-infected women in Harare, Zimbabwe. Southern African journal of HIV medicine, 21(1), p. 1123. Health and Medical Publishing Group 10.4102/sajhivmed.v21i1.1123

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Background

Human papillomavirus (HPV) associated invasive cervical cancer (ICC) is common in Zimbabwe, disproportionately affecting women living with HIV (WLHIV). Understanding high-risk HPV (hrHPV) infection in relation to cervical disease is important for ICC prevention amongst WLHIV.

Objectives

To describe the prevalence of cervical hrHPV, type distribution, associated risk factors and ICC screening outcomes in an urban cohort of Zimbabwean women.

Methods

In this cohort study, WLHIV were tested for hrHPV infection using the Cepheid Xpert® HPV assay and followed up for incident cervical disease. Follow-up assessments were done by visual inspection with acetic acid (VIA). Descriptive statistics and logistic regression were used to describe hrHPV burden and association between hrHPV and potential risk factors. Incidence rates (IR) and rate ratios of cervical disease by hrHPV infection status were also calculated.

Results

Amongst 321 WLHIV recruited, hrHPV prevalence was 24.9% (n = 80). Fifty-two of these women (65%) were positive for hrHPV types other than 16 or 18/45. Younger age (22-29 years), early sexual debut (13-16 years) and antiretroviral therapy (ART) regimen (second-line ART) were independently associated with hrHPV positivity. Positive VIA IR ratio between hrHPV-positive and -negative women was 12.57 (95% confidence interval [CI]: 4.14-38.19). Only women with hrHPV infection had incident cervical disease (IR: 6.41/100 person-years, (95% CI: 3.33-12.32). There were no ICC cases by the end of the 2-year follow-up.

Conclusion

There was a high prevalence of hrHPV infection other than 16 and 18/45 in this cohort. Integrating HPV testing in cervical cancer screening programmes may increase screening intervals in hrHPV-negative women, reducing costs for programmes. We recommend further research into cross protectivity of the bivalent and quadrivalent HPV vaccines against these other hrHPV types.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Shamu, Tinei

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2078-6751

Publisher:

Health and Medical Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

01 Dec 2020 21:42

Last Modified:

05 Dec 2022 15:42

Publisher DOI:

10.4102/sajhivmed.v21i1.1123

PubMed ID:

33240535

Uncontrolled Keywords:

HPV infection in WLHIV HPV vaccine cross protection cervical cancer screening hrHPV prevalence visual inspection with acetic acid

BORIS DOI:

10.7892/boris.148798

URI:

https://boris.unibe.ch/id/eprint/148798

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