HPV types, HIV and invasive cervical carcinoma risk in Kampala, Uganda: a case-control study

Abstract

BackgroundWhile the association of human papillomavirus (HPV) with cervical cancer is well established, the influence of HIV on the risk of this disease in sub-Saharan Africa remains unclear. To assess the risk of invasive cervical carcinoma (ICC) associated with HIV and HPV types, a hospital-based case-control study was performed between September 2004 and December 2006 in Kampala, Uganda. Incident cases of histologically-confirmed ICC (N=316) and control women (N=314), who were visitors or care-takers of ICC cases in the hospital, were recruited. Blood samples were obtained for HIV serology and CD4 count, as well as cervical samples for HPV testing. HPV DNA detection and genotyping was performed using the SPF10/DEIA/LiPA25 technique which detects all mucosal HPV types by DEIA and identifies 25 HPV genotypes by LiPA version 1. Samples that tested positive but could not be genotyped were designated HPVX. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression, adjusting for possible confounding factors. ResultsFor both squamous cell carcinoma (SCC) and adenocarcinoma of the cervix, statistically significantly increased ORs were found among women infected with HPV, in particular single HPV infections, infections with HPV16-related types and high-risk HPV types, in particular HPV16, 18 and 45. For other HPV types the ORs for both SCC and adenocarcinoma were not statistically significantly elevated. HIV infection and CD4 count were not associated with SCC or adenocarcinoma risk in our study population. Among women infected with high-risk HPV types, no association between HIV and SCC emerged. However, an inverse association with adenocarcinoma was observed, while decrease in CD4 count was not associated with ICC risk.ConclusionsThe ORs for SCC and adenocarcinoma were increased in women infected with HPV, in particular single HPV infections, infections with HPV16- and 18-related types, and high-risk HPV types, specifically HPV16, 18 and 45. HIV infection and CD4 count were not associated with SCC or adenocarcinoma risk, but among women infected with high-risk HPV types there was an inverse association between HIV infection and adenocarcinoma risk. These results suggest that HIV and CD4 count may have no role in the progression of cervical cancer.

HPV and cofactors for invasive cervical cancer in Morocco: a multicentre case-control study

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Vaccination against oncogenic human papillomavirus infection in HIV-infected populations: review of current status and future perspectives

“…Levin et al 31 conducted a double-blinded placebo-controlled safety and immunogenicity trial that enrolled and randomised 126 HIV-infected boys and girls aged [7][8][9][10][11][12] Number of studies included in the final review for the current study (6) Duplicates (10) Not written in English (10) Not meeting inclusion criteria (447) Fig. 1.…”

The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

“…While some studies [10]–[12], [15], [16]. reported an association between antiretroviral drugs use and a lower incidence of cervical lesions, others have reported no beneficial effect of antiretroviral drug use on the incidence of cervical lesions [7]–[12], [17], [18]. The inconsistency of findings in the cited studies might be the effect of small sample size, differing analytic techniques, viral diversity as well as timing and duration of treatment with antiretroviral drugs [14], [17].…”