Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya

Br J Cancer. 2012 Oct 23;107(9):1624-30. doi: 10.1038/bjc.2012.441. Epub 2012 Oct 2.

Abstract

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women.

Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy.

Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (P<0.001) and CIN2/3 among non-users of cART (P=0.013). Combination antiretroviral therapies users (≥2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users=0.77, 95% confidence interval (CI): 0.61-0.96) and multiple infections (PR=0.68, 95% CI: 0.53-0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age <35 years to 53.3% in ≥45 years.

Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies ( ≥2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / epidemiology*
  • Cervical Intraepithelial Neoplasia / virology
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • Humans
  • Kenya / epidemiology
  • Middle Aged
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / virology
  • Prevalence
  • Uterine Cervical Neoplasms / epidemiology*
  • Uterine Cervical Neoplasms / virology