Variability of high risk HPV genotypes among HIV infected women in Mwanza, Tanzania- the need for evaluation of current vaccine effectiveness in developing countries

Abstract

BackgroundHigh risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania.MethodsA cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11.ResultsA total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005)ConclusionSignificant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic.

The Human papillomavirus among women living with Human Immunodeficiency Virus in Morocco A prospective cross-sectional study

“…These findings highlighted that the HPV prevalence in the HIVpositive Moroccan women was significantly higher than observed in the general population (15.7%-43.1%) [6][7][8]. This seems to be in line with other previous reports which documents high proportion of HIVinfected women carrying varieties of HR-HPV types [27,28]. Furthermore, previous reports showed that HIV-infected women had a seven-fold increased rate of persistence of HR-HPV [29].…”

“…Furthermore, previous reports showed that HIV-infected women had a seven-fold increased rate of persistence of HR-HPV [29]. In addition, high HPV infection prevalence in HIV-positive women has been reported in Italy (44%) [30], US (54%-73%) [31], Brazil (48-78.8%) [32][33][34][35], South Africa (52.4%-74%) [36,37], Tanzania (54.1%) [27]and Burkina Faso (66.1%) [38]. However, a preliminary study carried out among 87 HIV-positive women in the Souss region (South of Morocco) reported a prevalence (39.3%) less than observed in our study [39].…”

“…Sociodemographic, behavioral, reproductive and lifestyle characteristics of the cohort are summarized in Table 1 [20][21][22][23][24][25][26][27]) and the majority of women were married or divorced (69.05%) and used oral contraceptive (66.93%). The educational level was illiterate for 36.25%, primary school for 32.27%, secondary school for 24.70% and high school for 6.78% of the women, respectively.…”

Human papillomavirus prevalence, genomic diversity and related risk factors in HIV-positive women from a countryside city in the state of Rio de Janeiro

“…1,28 An example of this association is the crosssectional study conducted by Mujuni et al, which evaluated 255 HIV-positive women and showed the presence of HPVpositive DNA in about 54% of patients, with high-risk HPV genotypes present in 48.6% of patients, culminating in a higher incidence of HPV positivity in patients with CD4 levels below 100 and the presence of intraepithelial lesions. 29 Our study also demonstrated the HPV genotype coverage inside the available vaccines. Although HIV-positive people generally show infection with multiple forms of HPV, we found that of 26 patients with genotypes identified, 23 (88.4%) and 25 (96.1%) of them had at least one genotype included in 4vHPV and 9vHPV, respectively.…”

A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

“… 29 The prevalence of specific high-risk HPV types such as HPV-52, HPV-58, HPV-35, and HPV-16 in HIV-positive women is itself a predictor for cervical disease that can be assessed through genotyping. 58 Other studies have evaluated the use of alternative triage methods for HPV-positive women. One of these is the identification of E6 protein because real-time nucleic acid sequence-based amplification has proven to allow type-specific detection of E6 mRNA from high-risk HPV types.…”