Human papillomavirus (HPV) infection, hiv infection and cervical cancer in Tanzania, East Africa

Meulen, Jan ter; Eberhardt, Hans; Luande, J.; Mgaya, H. N.; Chang‐Claude, Jenny; Mtiro, Hussein; Mhina, M.; Kashaija, P.; Ockert, S.; Yu, Xiu Ping; Meinhardt, G.; Gissmannl, L.; Pawlita, Michael

doi:10.1002/ijc.2910510403

Cited by 118 publications

(89 citation statements)

References 24 publications

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“…However most of subjects with SIL (88.9%) were significantly detected among HIV seropositive women. These results are consistent with other study reports elsewhere (Massad 1999;Moodley et al, 2006;Parham et al, 2006), however they differ from those reported in the study done in Dar es Salaam, Tanzania which showed that HIV serostatus was not significantly associated with SIL (Meulen et al 1992). This could have happened due to a number of reasons.…”

Section: Discussionsupporting

confidence: 85%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in Tanzanian women. Prevention of cervical cancer relies on the detection and treatment of Squamous Intraepithelial Lesion (SIL), a premalignant disease stage. Worldwide there are overwhelming reports associating SIL and HIV infection, however in Tanzania such reports are limited. A cross-sectional hospital-based descriptive study was conducted to determine the prevalence and severity of SIL in 234 HIV seropositive and seronegative women aged 18-68 years old at Kilimanjaro Christian Medical Centre in northern Tanzania. A structured questionnaire was used to collect sociodemographic data. In addition, blood was collected for rapid HIV antibody testing and CD4+ T-lymphocyte counts to associate with prevalence and severity of SIL from the cervical smear collections. A total of 214 subjects had smear results regarded as valid for interpretation, of which 46.3% were HIV seropositive. Overall rate of SIL was 17%. Proportion of SIL among HIV seropositive subjects was 32% versus 4% in seronegative subjects (OR=13.3, 95% CI=4.2-46.4). Low CD4+ Tlymphocyte cell count was associated with higher prevalence of SIL (P=0.001). The relationship between CD4+ T-lymphocyte cell counts and the severity of cervical SIL was significant (P=0.007). Marital status and number of lifetime sex partners were risk factors significantly associated with SIL (P=0.004 and 0.005, respectively). SIL was not associated with age, education level, parity or age at sex debut. The prevalence and severity of cervical SIL was significantly associated with HIV infection and immunologic disease progression. These findings underscore the need for HIV screening among women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status and number of lifetime sex partners were significant risk factors associated with SIL. _______________________________________________________________________________________

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Section: Discussionsupporting

confidence: 85%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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“…Previous studies have reported a high prevalence of multiple HPV infections among HIV-infected women (Palefsky et al, 1999;Gravitt et al, 2002) which is associated with an increased risk of intraepithelial neoplasia and of cancer (Moscicki et al, 2004a;Herrero et al, 2005). As was found in other African studies (Ter Meulen et al, 1992;Chabaud et al, 1996;La Ruche et al, 1998;Bayo et al, 2002;Kay et al, 2003), HPV-16 and -18 were less common than other HR-HPV types overall, but they were involved in 64% of HSIL lesions, while 93% of women with HSIL had viruses related to the HPV-16 or HPV-18 phylogenetic groups. Therefore, administration of a bivalent HPV-16/18 vaccine in this population before they get exposed might have the potential to prevent the majority of highgrade lesions in this population, but this would need to be determined in prospective studies.…”

Section: Discussionsupporting

confidence: 52%

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

et al. 2006

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Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2 -7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio ( Cervical cancer is the most frequent cancer of women in developing countries, particularly in sub-Saharan Africa (Parkin et al, 1999), and it is now well established that genital infection with certain types of human papillomavirus (HPV) causes virtually all cases of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer (ICC) (Walboomers et al, 1999). The HPV types that infect the genital tract have been subdivided into low-risk (LR) types, which are principally found in nonmalignant lesions such as genital warts, and high-risk (HR) types, which are associated with the development of CIN and ICC. Human papillomavirus types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and 89 are classified as LR types, whereas types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 are classified as HR types. In addition, HPV types 26, 53, and 66 are considered as probably carcinogenic (Muñoz et al, 2003).Human papillomavirus prophylactic vaccines are now being developed and promising results have been obtained with recombinant L1 capsid protein virus-like particles (VLPs). However, the current HPV vaccines target the most prevalent high-risk HPV (HR-HPV) types worldwide, namely HPV-16 and HPV-18 (Koutsky et al, 2002;Ault et al, 2004;Brown et al, 2004;Harper et al, 2004). It has been shown that crossneutralisation induced by L1 VLPs represents less than 1% of the neutralising activity induced by the dominant conformational epitope , indicating that current HPV vaccines would be able to confer only type-specific immunity. Therefore, effectiveness of these vaccines on the prevention of cancer may be lower in populations highly affected by HR-HPV types other than HPV-16 and HPV-18. Thus, it is important to document the distribution of HPV genotypes in HPV-infected women and in women with cervical neoplasia in African countries in order to assess the potential effectiveness of a bivalent HPV-16/18 vaccine.There have been few detailed studies of HPV genotypes and their association with intraepithelial lesions or ICC in sub-Saharan Africa. Available data suggest, however, a higher prevalence and wider spectrum of oncogenic HPV types compared to studies conducted elsewhere (Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Clifford et al, 2005;Wall et al, 2005). Furthermore, the high backgr...

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“…1 The incidence of infection with either high-or low-risk HPV types in the female population of East and Central Africa, as elsewhere, reaches 40 -90%. [1][2][3][4] Notwithstanding that high number, only relatively few women will develop the cancer.…”

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confidence: 99%

Cancer of the uterine cervix may be significantly associated with a gene polymorphism coding for increased IL-10 production

et al. 2001

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The purpose of our prospective, case-controlled study was to investigate the hypothesis that women who are genetically programmed to produce high or medium levels of IL-10 were more likely to develop cancer of the uterine cervix than individuals genetically predisposed to low IL-10 production. The population was recruited from patients attending gynecological clinics at 2 hospitals in Harare, Zimbabwe. Laboratory tests were performed in the Departments of Immunology, Chemical Pathology and Medical Microbiology, Medical School, University of Zimbabwe, and simultaneously at the Department of Biological Sciences, University of Manchester, United Kingdom. Included in our study were 77 women with histologically proven cancer of the uterine cervix and 69 age-and parity-matched healthy women. All of the patients and healthy controls were from the Shona ethnic group that inhabits northern Zimbabwe. DNA was purified from cervical cytobrush samples obtained from women with cervical cancer. Control DNA was extracted from urine or peripheral blood samples from the healthy women. The Qiagen DNA extraction kit was used. Detection of allele A and/or G at ؊1082 in the promoter region of the IL-10 gene was carried out using the ARMS-PCR technique. Polymorphism in the amplified products was detected by gel electrophoresis in the presence of ethidium bromide and were bands visualized under UV light. The data comprise 77 women who developed invasive cervical cancer and 69 healthy women matched for age and parity. Patients with cancer were significantly (p ‫؍‬ 0.001) more likely to be predisposed to produce higher (A/G) levels of IL-10. The genotype encoding for high (G/G) production of IL-10 was only observed in one cancer patient. The prevalence of low producers of IL-10 in the cancer group was significantly lower than in the healthy women. There were no high producers amongst the healthy women. These data suggest that the genetically acquired ability to produce higher levels of IL-10 may be a significant factor in the development of cervical cancer.

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Human papillomavirus (HPV) infection, hiv infection and cervical cancer in Tanzania, East Africa

Cited by 118 publications

References 24 publications

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

Cancer of the uterine cervix may be significantly associated with a gene polymorphism coding for increased IL-10 production

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