HPV Positivity and Risk of Cervical Cancer according to HIV-Infection: A Comparative Assessment in the Population of Cameroonian Women

Abstract

Background Cervical cancer, caused by the human papillomavirus (HPV), remains a global health challenge. In HIV highly-burdened settings, it would be relevant to understand the severity of cervical cancer in case of co-infection with HPV. We therefore sought to determine the effect of HPV on the occurrence of cervical lesions among women with versus without HIV-infection. Methods A cross-sectional analytical study was conducted throughout 2012 among 257 women living in Yaoundé, Cameroon. HIV serology, genotyping of high-risk oncogenic HPV and cervical vaginal smear (CVS) were performed for all participants; among those reported to be HIV seropositive, HIV plasma viral load and CD4 count were measured. Results of the CVS were interpreted following the Bethesda 2001 guidelines. Statistical analyses were performed using Graph Pad version 6.0; p < 0.05 was considered statistically significant. Results The mean age of our study participants was 37 ± 6.5 years. According to HIV serology, 184 (71.59%) were HIV-positive vs. 73 (28.40%) HIV-negative women, with a similar age distribution respectively (36 ± 2.80 years versus 42 ± 8.48 years). Among HIV-positive women, median CD4 was 438 [IQR: 317–597] cells/mm3 and median viremia < 40 [IQR: <40 − 2318] copies/mL. Following successful genotyping, the prevalence of high-risk oncogenic HPV was 36.32% (73/201), with a significantly higher proportion among those with HIV-infection (41.98% [55/131] vs. 25.71% [18/70]; p = 0.02; OR = 2.1). CVS revealed 31.74% (97) normal cervix; 38.91% (100) inflammation; 16.34% (42) low-grade squamous intra-epithelial lesion; 6.34% (18) high-grade squamous intra-epithelial lesion. Overall rate of cervical lesions was 23.34% (60/257), with a non-significantly higher proportion in HIV-infected participants (25.00% [46/184] versus 19.17% [14/73]; p = 0.31). Of relevance, the presence of high-risk oncogenic HPV was significantly associated with cervical lesions (p < 0.0001; OR = 5.07), with a higher risk of cervical lesion among HIV-positive (p < 0.0001 and OR = 5.67) versus HIV-negative (p = 0.03 and OR = 3.83). Conclusion Though oncogenic HPV appears as an independent factor of the occurrence of cervical lesions, the risk of cervical lesion is substantially higher among HIV/HPV co-infection compared to HPV-infection alone. Thus, prevention of cervical cancer should be prioritised for women living with HIV-infection in HPV-endemic settings.