Human papillomavirus (HPV) genotypes and associated cervical disease in an anti-retroviral setting in Accra, Ghana

Abstract

Background The vast majority of women diagnosed with HIV/AIDS are found in the Sub-Saharan African region. These women have a high chance of being infected with human papillomaviruses (HPV), which causes cervical cancer and precursor lesions. Early initiation of HAART coupled with a high HAART compliance may reduce disease burden, but in Ghana, little is known about the distribution of HPV infections and epithelial changes in this vulnerable group. Methods This work was carried out to establish the distribution of genital HPV genotypes among women living with HIV attending a special HIV outpatient clinic at the Korle-Bu Teaching hospital Accra, Ghana. Pap smears were performed for 538 selected women. A highly sensitive nested multiplex PCR (NMPCR) assay was conducted for the detection and typing of human papillomavirus (HPV) genotypes. These included, 6/11, 16,18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, and 68. Cervical smears were examined for cytologic abnormalities by two cytologists and verified by a pathologist. Results Coverage of HAART in this population was 84%. HPV DNA was detected in 280 out of the 538 individuals studied, 52.0% (95%CI 47.7–56.3). Out of these 129 (46.1%, 95%CI 40.1–52.1) had multiple HPV infections and 151 (53.9%, 95%CI 47.9–59.9) had single infections. The prevalence of LR HPV was 10.2% (95% CI: 11.3–17.6). while that of HR HPV was 29.7% (95% CI: 27.4–35.7). The commonest HR types were, 35 ,18 ,58 ,52 and 45 in descending order. The frequency of HPV 16 was 2.4%. Cytologically, 2.8% had ASCUS, 3.9% LGSIL and 2.8% HGSIL, none of the women was found to have atypical glandular cells or adenocarcinoma. The commonest HPV genotypes detected among women with ASCUS were HPV-18 (25% of all ASCUS cases), 52 (25% of all ASCUS cases) and 68 (25% of all ASCUS cases). Among women with LSIL most prevalent were HPV-52 (66.5% of all LSIL cases), HPV-18 (22.2% of all LSIL cases) and HPV 45 (22.2% of all LSIL cases). HPV-16, 52 and 42 were each found in 50% of all High-grade lesions., being the top three in that order for high grade intraepithelial/severe dysplasia lesions Conclusions There is a high burden of HPV infection in women living with HIV attending clinic at the KBTH. Given the high prevalence of HIV-HPV coinfection despite the high coverage of HAART, associated cervical lesions represent a major public health burden. These results show that currently available prophylactic vaccines have the potential to be useful in the primary prevention of HPV infections among immunocompromised women. This study also found a cross-sectional association between early age at first sex and the presence of precancerous cervical lesions. Efforts to make vaccines available to young girls before sexual debut should be prioritized along with education on safe sexual habits.