Human papillomavirus in a rural community in Zimbabwe: The impact of HIV co‐infection on HPV genotype distribution

Abstract

Cervical cancer is a leading cause of cancer-related deaths in developing countries, and the human papillomavirus (HPV) is linked etiologically to cervical cancer. Hence, a vaccine which prevents HPV-associated cervical cancer would have the most impact in developing countries, including the African continent. The type-specific immune response towards HPV virus-like particles, in combination with geographical variation in the prevalence of HPV, necessitates the presence of multiple HPV type antigens in a single vaccine cocktail in order to provide relevant protection. We aimed to investigate whether co-infection with HIV, which is highly prevalent in Africa, plays a role in HPV genotype distribution. After informed consent, HPV detection by GP5+/6+ PCR and HIV detection by serology was carried out on 236 women from the rural north-western part of Zimbabwe. The prevalence of HPV was higher in HIV positive women (54%) than in HIV negative women (27%). Certain HPV types (HPV types 11, 39, 43, 51, and 59, P-values ranging from 0.017 to 0.067) occurred more frequently in HIV positive women. Only high-risk HPV, and not HIV, was associated significantly with cervical intraepithelial neoplasia in multiple regression analysis. In conclusion, a high prevalence of HPV was found in a rural community, where regular Papanicolaou (Pap) smears would be a logistic and economic impossibility, but where free vaccination programmes against other infections are already established. The results suggest that HIV co-infection may have an impact on HPV genotype distribution.

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

“…Human papillomavirus-52, HPV-35, and HPV-58 were the most prevalent types in the present study. A high prevalence of these HPV types has been also observed in other African studies (Gravitt et al, 2000;Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Xi et al, 2003;Baay et al, 2004;Thomas et al, 2004;Wall et al, 2005).…”

“…Positive HPV samples were typed by LiPA and by sequencing when LiPA was inconclusive, leaving no sample unidentified. While the epidemiology of genital HPV types has been relatively better studied in Southern and Eastern African countries such as Kenya (Temmerman et al, 1999;De Vuyst et al, 2003), Malawi (Miotti et al, 1996), Mozambique (Castellsague et al, 2001), Tanzania (Mayaud et al, 2003), Uganda (Serwadda et al, 1999), and Zimbabwe (Gravitt et al, 2002;Baay et al, 2004), data from Western Africa have been scarce. The prevalence of HPV infection and associated cervical lesions have been studied in Ivory Coast (La Ruche et al, 1998) and Mali (Bayo et al, 2002), but detailed HPV types were only reported from Senegal (Xi et al, 2003), Nigeria (Thomas et al, 2004), and The Gambia (Wall et al, 2005).…”

“…The prevalence of HPV infection and associated cervical lesions have been studied in Ivory Coast (La Ruche et al, 1998) and Mali (Bayo et al, 2002), but detailed HPV types were only reported from Senegal (Xi et al, 2003), Nigeria (Thomas et al, 2004), and The Gambia (Wall et al, 2005). Prevalence rates of HPV infection ranging from 13 to 40% have been reported from low-risk or general populations of sub-Saharan African countries (Miotti et al, 1996;Temmerman et al, 1999;Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Xi et al, 2003;Baay et al, 2004;Thomas et al, 2004;Wall et al, 2005). The 66% prevalence found in the present study, which is still much higher than the 40% prevalence found in similar highrisk populations in Africa (Kreiss et al, 1992;Langley et al, 1996;Piper et al, 1999), might reflect the high sexual exposure of our study population and, as mentioned earlier, may be attributed in part to the exhaustive nature of our HPV detection strategy.…”

HPV infection in women with and without cervical cancer in Conakry, Guinea

“…By contrast, in IARC HPV Prevalence Surveys in India and China it was considered socially unacceptable to invite unmarried women Dai et al, 2006;Li et al, 2006;Wu et al, 2007). In some earlier studies from subSaharan Africa, HPV prevalence also remained high (Kuhn et al, 2000;Thomas et al, 2004;Wall et al, 2005) or even increased (Xi et al, 2003) in middle and old age, whereas peaks in young women were reported by other investigators (Serwadda et al, 1999;Womack et al, 2000;Castellsagué et al, 2001;De Vuyst et al, 2003;Baay et al, 2004). With respect to the relative importance of different HPV types, HPV16 was the commonest type overall, that is, 13.9%, 17.7% and 48.6%, respectively, in cytologically normal and abnormal women and in women with ICC (Clifford et al, 2005;Smith et al, 2007).…”

The Viral Etiology of AIDS‐Associated Malignancies

“…These neoplasms are responsible for extensive morbidity and mortality. In Zambia and other subSaharan nations, cervical cancer is the most common cancer (Baay et al, 2004;Hawes et al, 2003;Xi et al, 1998Xi et al, , 2003. Although in Africa, public education campaigns about STDs and condoms have been instituted in urban areas, there has been little success in poorer rural areas (Agha and Kusanthan, 2003).…”