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

Mandiriri, Ardele; Pascoe, Margaret; Shamu, Tinei; Lowe, Sara

doi:10.4102/sajhivmed.v21i1.1123

Cited by 3 publications

(5 citation statements)

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“… 21 , 22 It also highlights the important role of cervical cancer screening programs to reduce the incidence of cervical cancer. 23 , 24 Furthermore, consistent with other studies, our results showed that initiating ART at higher CD4 cell counts reduced the overall risk of developing cancer. 25 , 26 Enhanced efforts toward HIV testing and early ART initiation as prescribed in the WHO “test‐and‐treat” drive is likely to reduce cancer incidence among PLWH.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

“…The high burden of HPV associated cancers in our study reinforces the urgency of accelerating HPV vaccination programs to advance toward the 90‐70‐90 targets of eliminating cervical cancer as a public health problem by 2030 21,22 . It also highlights the important role of cervical cancer screening programs to reduce the incidence of cervical cancer 23,24 . Furthermore, consistent with other studies, our results showed that initiating ART at higher CD4 cell counts reduced the overall risk of developing cancer 25,26 .…”

Section: Discussionsupporting

confidence: 90%

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Cancer incidence among people living with HIV in Zimbabwe: A record linkage study

et al. 2021

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Background People living with HIV (PLWH) are at increased risk of developing cancer. Cancer diagnoses are often incompletely captured at antiretroviral therapy (ART) clinics. Aim To estimate the incidence and explore risk factors of cancer in a cohort of PLWH in Harare using probabilistic record linkage (PRL). Methods We conducted a retrospective cohort study that included PLWH aged ≥16 years starting ART between 2004 and 2017. We used PRL to match records from the Zimbabwe National Cancer Registry (ZNCR) with electronic medical records from an ART clinic in Harare to investigate the incidence of cancer among PLWH initiating ART. We matched records based on demographic data followed by manual clerical review. We followed PLWH up until first cancer diagnosis, death, loss to follow‐up, or 31 December 2017, whichever came first. Results We included 3442 PLWH (64.9% female) with 19 346 person‐years (PY) of follow‐up. Median CD4 count at ART initiation was 169 cells/mm 3 (interquartile range [IQR]: 82–275), median age was 36.6 years (IQR: 30.6–43.4). There were 66 incident cancer cases for an overall incidence rate of 341/100 000 PY (95% confidence interval [CI]: 268–434). Twenty‐two of these cases were recorded in the ZNCR only. The most common cancers were cervical cancer ( n = 16; 123/100 000 PY; 95% CI: 75–201), Kaposi sarcoma, and lymphoma (both n = 12; 62/100 000 PY; 95% CI: 35–109). Cancer incidence increased with age and decreased with higher CD4 cell counts at ART initiation. Conclusion PRL was key to correct for cancer under‐ascertainment in this cohort. The most common cancers were infection‐related types, reinforcing the role of early HIV treatment, human papillomavirus vaccination, and cervical cancer screening for cancer prevention in this setting.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

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Cancer incidence among people living with HIV in Zimbabwe: A record linkage study

et al. 2021

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“…The prevalence of hr-HPV from the current study is higher than the (19.6%) that found among WLWH in cervical cancer screening centers in Ogun and Lagos states, Nigeria [30] and antiretroviral clinic of the Federal Medical Center (36%), Keffi, Nigeria [31]. In Zimbabwe [32], also reported about 25% hr-HPV prevalence which is also lower than the findings from this study. Some other SSA countries such as Burundi, 45.7% [33], Kenya 47% [34] and 64% [35] have been reported.…”

Section: Discussioncontrasting

confidence: 89%

“…This is also in agreement with [30] where lower prevalence of hr-HPV was found among HIV infected women using ART in Nigeria. Other evidence supporting the influence of ART on cytology have been found in Nigeria [48] and Zimbabwe [32].…”

Section: Plos Onementioning

confidence: 83%

Prevalence and risk factors associated with high-risk human papillomavirus infection among women living with HIV (WLWH) at a tertiary health facility in Accra, Ghana

Agyare Gyane,

Modey,

Maya

et al. 2024

PLoS ONE

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Background Women living with HIV (WLWH) have high risk of developing cervical cancer. High- risk Human papillomavirus (hrHPV) is the single most important cause of cervical cancer. Vaccination for and early detection of pre-malignant cervical changes, through cervical cancer screening contributes to prevention of cervical cancer. This study sought to determine the prevalence of HPV among WLWH, genotypes present and the risk factors associated with cervical cancer development. Methods and findings An analytical cross-sectional study of 250 sexually active women aged 18 years and above, attending HIV clinic at a tertiary health facility in Accra. Demographic data collection and risk factor assessments were done using interviewer-administered questionnaire, and patient records. Cervical swabs were collected and tested for HPV using real-time PCR assays. Genotype analysis was performed on 92 samples. Descriptive statistics and logistic regression analysis were used to establish associations between hrHPV and risk factors among WLWH. Approximately 60% of study participants tested positive for HPV. The prevalence of hr-HPV among WLH was 44.4%. Factors identified to be protective of hrHPV were employment (AOR = 0.19, 95% CI = 0.06, 0.56, p = 0.003) and highly active antiretroviral therapy (HAART) Tenofovir-Lamivudine-Ritonavir-Lopinavir (TLRL) (AOR = 0.30, 95% CI = 0.09, 0.95, p = 0.04). Women with HIV diagnosis within 6 to10 years (AOR = 4.89, 95% CI = 1.05, 22.70, p = 0.043) and diagnosis >10 years (AOR = 8.25, 95% CI = 1.24, 54.84, p = 0.029) had higher odds of hrHPV. Approximately 25% of samples analysed tested positive for hr-HPV group 1 (genotypes 16, 18, 31, 33, 35, 39, 45,51, 52, 56, 58, 69) and 46.8% for multiple HPV genotypes. Conclusion A high prevalence of genotypes that include high risk genotypes 16 and 18 and multiple HPV infections was found among WLWH. Almost half of the women screened had high-risk HPV and were prone to cervical cancer without their knowledge. Regular HPV screening is recommended for high-risk patient groups.

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Human papillomavirus spectrum of HPV-infected women in Nigeria: an analysis by next-generation sequencing and type-specific PCR

Dom-Chima,

Ajang,

Dom-Chima

et al. 2023

Virol J

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Background Human papillomavirus (HPV) infection and cervical cancer are leading health problems and causes of death in many parts of the world. There are ~ 200 HPV types that can infect humans. This study aims to understand the spectrum of HPV infections in Nigerian women with normal or abnormal cytology. Methods We screened cervical samples from 90 women with possible HPV infections collected in two regional hospitals in Nigeria. The first screening was done using next-generation DNA sequencing (NGS), identifying multiple HPV types in many samples. Thereafter, type-specific PCR analysis was used to verify the NGS-identified HPV types in each sample. Results NGS analysis of the 90 samples from the Nigerian cohort identified 44 HPV types. The type-specific PCR confirmed 25 HPV types out of the 44 HPV types detected by NGS, and ~ 10 of these types were the most prevalent. The top five prevalent types found in the Nigerian cohort were HPV71 (17%), HPV82 (15%), HPV16 (16%), HPV6 (10%), and HPV20 (7%). Among the PCR-confirmed HPV types, we found 40.98% high-risk HPV types, 27.22% low-risk HPV types, and 31.15% undetermined HPV types. Among these 25 HPV types in Nigeria, only six were included in the current nine-valent HPV vaccine. We also observed strikingly high multiple HPV infections in most patients, with as many as nine HPV types in a few single samples. Conclusions Our NGS-PCR approach of HPV typing in the Nigerian cohort samples unveiled all possible HPV types currently circulating in Nigerian people. We confirmed 25 HPV types using NGS and PCR, with many samples infected with multiple HPV types. However, only six of these types are part of the nine-valent HPV vaccines indicating the need to develop region-specific selective vaccines.

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

Cited by 3 publications

References 34 publications

Cancer incidence among people living with HIV in Zimbabwe: A record linkage study

Cancer incidence among people living with HIV in Zimbabwe: A record linkage study

Prevalence and risk factors associated with high-risk human papillomavirus infection among women living with HIV (WLWH) at a tertiary health facility in Accra, Ghana

Human papillomavirus spectrum of HPV-infected women in Nigeria: an analysis by next-generation sequencing and type-specific PCR

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