Genital warts and infection with human immunodeficiency virus in high-risk women in Burkina Faso: a longitudinal study

Abstract

BackgroundHuman papillomaviruses are the most common sexually transmitted infections, and genital warts, caused by HPV-6 and 11, entail considerable morbidity and cost. The natural history of genital warts in relation to HIV-1 infection has not been described in African women. We examined risk factors for genital warts in a cohort of high-risk women in Burkina Faso, in order to further describe their epidemiology.MethodsA prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso. Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections. In a subset of 306 women, cervical HPV DNA was tested at enrolment.ResultsGenital wart prevalence at baseline was 1.6% (8/492) among HIV-uninfected and 7.0% (19/273) among HIV-1 seropositive women. Forty women (5.2%) experienced at least one incident GW episode. Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤200 cells/μL. Incident genital warts were also associated with concurrent bacterial vaginosis, and genital ulceration. Antiretroviral therapy was not protective against incident or persistent genital warts. Detection of HPV-6 DNA and abnormal cervical cytology were strongly associated with incident genital warts.ConclusionsGenital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population.

Antiretroviral Therapy Uptake, Attrition, Adherence and Outcomes among HIV-Infected Female Sex Workers: A Systematic Review and Meta-Analysis

“…In the Kenyan study, the fraction of FSWs with CD4 counts ≤200 cells/mm 3 , decreased from 90% at ART initiation to 11% after 24 months on ART [32] (Figure 10A, Table S5B). When pooling the most recent study estimates from the 2 study populations, the overall pooled fractions of FSWs on ART with CD4 counts <200 cells/mm 3 , 200–499 cells/mm 3 , and >500 cells/mm 3 , were 22% (95% CI: 5%–66%, I 2  = 88%, N s  = N p  = 2), 63% (95% CI: 28%–89%, I 2  = 89%, N s  = N p  = 2), and 13% (95% CI: 7%–22%, I 2  = 0%, N s  = N p  = 2), respectively [32], [37] (Figure 10). …”

Incident Anal Human Papillomavirus and Human Papillomavirus–Related Sequelae in HIV-Infected Versus HIV-Uninfected Adolescents in the United States

“…Similar to the current study, previous studies demonstrate higher prevalence of anal HPV 9 and cervical HPV 18 in HIV-infected vs. HIV-uninfected adolescent women, and higher incidence of genital warts in HIV-infected vs. HIV-uninfected adult women. 19 Because HIV-infected adolescent women are at higher risk of acquiring anal HPV and developing HPV-related sequelae when compared to their HIV-uninfected peers, enhanced HPV prevention efforts targeting HIV-infected adolescent women are needed. Such prevention efforts should include developmentally appropriate education about HPV and administration of the HPV vaccine.…”

Combination antiretroviral therapy reduces the detection risk of cervical human papilloma virus infection in women living with HIV

“…In another study that enrolled 45 MSM, a high prevalence of anal HPVand HSIL remained despite immune restoration under cART [21]. When looking more specifically at incident HPV detection, two more recent study reports also failed to show a protective effect of cART [22,23].…”