Long-term risk and predictors of high-risk human papillomavirus persistence after thermal ablation amongst women living with HIV in West Africa

Abstract

Introduction: Mounting evidence supports the use of thermal ablation in women positively screened with high-risk Human Papillomaviruses (hrHPV) but limited data are available on the long-term post-treatment outcomes in women living with HIV (WLHIV). We aimed to estimate the persistence of hrHPV infection amongst WLHIV ≥24 months post treatment in West Africa.

Methods: From October 2019 to October 2024, a cohort study was conducted amongst WLHIV in two HIV clinics in Burkina Faso and Cote d'Ivoire. All WLHIV with a positive hrHPV test who received thermal ablation were followed up ≥24 months. During follow-up visits, DNA HPV testing, visual inspection and biopsy were systematically performed. Factors associated with ≥24 months hrHPV positivity were assessed through a logistic regression model.

Results: A total of 200 WLHIV, aged 42 years [Interquartile range (IQR): 38-45], with a nadir CD4 of 365 [IQR: 168-616] cell/mm³ received thermal ablation and were followed for a median time of 42 [IQR: 29-48] months. A positive hrHPV was detected in 40.5% of women ≥24 months post treatment. WLHIV who had a nadir CD4 count ≤200 cell/mm³ (aOR = 3.06 [95% CI: 1.23-7.59]) or had no or a primary school level (aOR = 2.25 [95% CI: 1.13-4.49]) were more likely to present at ≥24 months with hrHPV infection.

Conclusion: Post-therapeutic hrHPV infection remains high beyond 2 years in WLHIV stressing the need for long-term follow-up, especially when diagnosed with advanced HIV disease. Future implementation research should focus on the contribution of additional tools to better track those in need of additional treatment.

Keywords: HIV; West Africa; high‐risk human papillomaviruses; persistence; precancerous lesions.