Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women

Abstract

Objectives: Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia. Methods: Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic and behavioral characteristics. Results: HIV-infected women were older and less likely to be married and to own a home and had more lifetime sexual partners than HIV-uninfected women. All HIV-infected women were receiving anti-retroviral therapy at enrollment and had satisfactory CD4 cell counts and HIV viral loads. One- and two-year persistent human papillomavirus detection was significantly associated with HIV infection for any human papillomavirus, high-risk human papillomavirus, International Agency for the Research on Cancer-classified high-risk human papillomavirus, and non-oncogenic “low-risk” human papillomavirus. Conclusion: Persistent detection of oncogenic and non-oncogenic human papillomavirus was strongly associated with HIV infection in Kenyan women with re-constituted immune systems based on satisfactory CD4 cell counts. In addition to HIV infection, factors associated with an increased risk of human papillomavirus persistence included a higher number of lifetime sex partners. Factors associated with decreased risk of human papillomavirus persistence included older age and being married. Further studies are needed to identify the immunological defects in HIV-infected women that allow human papillomavirus persistence, even in women receiving effective anti-retroviral therapy. Further studies are also needed to determine the significance of low-risk human papillomavirus persistence in HIV-infected women.

Association of plasma aflatoxin with persistent detection of oncogenic human papillomaviruses in cervical samples from Kenyan women enrolled in a longitudinal study

“…They were participants in a prospective cohort study investigating biological, behavioral, and environmental risk factors for oncogenic HPV persistence, a part of the East African Consortium for Human Papillomavirus and Cervical Cancer in Women Living with HIV/AIDS [ 16 ]. Details of study enrollment procedures have been previously published [ 11 ]. Briefly, women aged 18 to 60 years living within 30 km of Eldoret presenting for screening at the CCSP were asked to participate in the study if they had a normal visual inspection with acetic acid (VIA) of the uterine cervix that day.…”

“…Structured face-to-face interviews of the participants by trained researchers were conducted at enrollment to capture social, behavioral, and biological information, including age, marital status, educational level, home ownership, walking distance to the local clinic, number of lifetime sexual partners, and age of first sex [ 11 ].…”

“…HIV infection is one cofactor that imparts a higher likelihood of HR-HPV persistence [ 2 , 8 , 9 ]. HR-HPV detection and persistence are also prevalent among Kenyan women who are not HIV-infected [ 10 , 11 ].…”

The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

“…A cohort was enrolled in 2015 to 2016 consisting of 116 HIV-infected and 106 HIV-uninfected women aged 18 to 45 years, with normal VIA that day at the AMPATH Cervical Cancer Screening Program (CCSP), located at MTRH, in Eldoret, Kenya [ 34 ]. Studies conducted as part of in Project 1 indicated that oncogenic and non-oncogenic HPV types were detected more often among HIV-infected women compared with HIV-uninfected women, and that persistent HPV (one-year persistence or two-year persistence) was more often detected among HIV-infected women than HIV-uninfected women [ 35 ]. In addition, a longer duration of ART use was associated with significantly reduced risk of HR-HPV detection and persistence [ 36 ].…”

Longer duration of anti-retroviral therapy is associated with decreased risk of human papillomaviruses detection in Kenyan women living with HIV

“…Characteristics of age, marital status, education, home ownership, walking distance to health care, number of lifetime sex partners, and age of first sex with a p-value <0.20 from univariate analyses were selected to include in the model. LR-HPV (low-risk HPV):HPV 6,11,40,42, 54, 55, 61, 62, 64, 71, 72, 81, 83, 84, CP6108.…”