Cervical Dysplasia, Infection, and Phylogeny of Human Papillomavirus in HIV-Infected and HIV-Uninfected Women at a Reproductive Health Clinic in Nairobi, Kenya.

Agnes Omire,Washingtone Ochieng,Danvas Kerosi,Raphael Lwembe,Nancy L M Budambula,Hillary Langat,Leah Kirumbi

doi:10.1155/2020/4945608

Abstract

High risk human Papillomavirus (HPV) infections ultimately cause cervical cancer. Human Immunodeficiency Virus (HIV) infected women often present with multiple high-risk HPV infections and are thus at a higher risk of developing cervical cancer. However, information on the circulating high-risk HPV genotypes in Kenya in both HIV-infected and HIV-uninfected women is still scanty. This study is aimed at determining the phylogeny and the HPV genotypes in women with respect to their HIV status and at correlating this with cytology results. This study was carried out among women attending the Reproductive Health Clinic at Kenyatta National Hospital, a referral hospital in Nairobi, Kenya. A cross-sectional study recruited a total of 217 women aged 18 to 50 years. Paired blood and cervical samples were obtained from consenting participants. Blood was used for serological HIV screening while cervical smears were used for cytology followed by HPV DNA extraction, HPV DNA PCR amplification, and phylogenetic analysis. Out of 217 participants, 29 (13.4%) were HIV seropositive, while 68 (31.3%) were positive for HPV DNA. Eight (3.7%) of the participants had abnormal cervical cytology. High-risk HPV 16 was the most prevalent followed by HPV 81, 73, 35, and 52. One participant had cervical cancer, was HIV infected, and had multiple high-risk infections with HPV 26, 35, and 58. HPV 16, 6, and 81 had two variants each. HPV 16 in this study clustered with HPV from Iran and Africa. This study shows the circulation of other HPV 35, 52, 73, 81, 31, 51, 45, 58, and 26 in the Kenyan population that play important roles in cancer etiology but are not included in the HPV vaccine. Data from this study could inform vaccination strategies. Additionally, this data will be useful in future epidemiological studies of HPV in Nairobi as the introduction or development of new variants can be detected.

Highlights

Human Papillomaviruses (HPVs) are divided into three groups [1]
When HPV infection was assessed by marital status, single women had the highest rates of infection (p = 0:004)
There was no association between HPV infection and level of education (p = 0:714), family planning (p = 0:072), and the number of children (p = 0:089)

Summary

Introduction

Group 1 HPV is known to be carcinogenic and includes HPV 16, 18, 31, 33, 35, 45, 52, and 58. The most prevalent HPV genotypes globally in a decreasing order are HPV 16, 18, 33, 45, 31, 58, 52, 35, 59, 56, 51, 39, 6, 68, 73, 66, and 70 [2]. HPV infection is the main risk factor for cervical cancer which is the leading cause of mortality in Africa [3, 4]. Compared to HIV-uninfected women, HIV-infected women are at an increased risk for HPV infection and tend to be infected with multiple genotypes of HPV [5,6,7]. HIVinfected women are more likely to be infected with high-risk HPV genotypes that are not in the HPV vaccines [8]. The most oncogenic HPV is the alpha 9 (16, 31, 35, 58, 67, and 52) and alpha 7 (59, 18, 45, 70, 39, 68, and 85)

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Discussion

Conclusion