Abstract
South African women have a high rate of cervical cancer cases, but there are limited data on human papillomavirus (HPV) genotypes in cervical intraepithelial neoplasia (CIN) in the Eastern Cape province, South Africa. A total of 193 cervical specimens with confirmed CIN from women aged 18 years or older, recruited from a referral hospital, were tested for HPV infection. The cervical specimens, smeared onto FTA cards, were screened for 36 HPV types using an HPV direct flow kit. HPV prevalence was 93.5% (43/46) in CIN2 and 96.6% (142/147) in CIN3. HIV-positive women had a significantly higher HPV prevalence than HIV-negative women (98.0% vs. 89.1%, p = 0.012). The prevalence of multiple types was significantly higher in HIV-positive than HIV-negative women (p = 0.034). The frequently detected genotypes were HPV35 (23.9%), HPV58 (23.9%), HPV45 (19.6%), and HPV16 (17.3%) in CIN2 cases, while in CIN3, HPV35 (22.5%), HPV16 (21.8%), HPV33 (15.6%), and HPV58 (14.3%) were the most common identified HPV types, independent of HIV status. The prevalence of HPV types targeted by the nonavalent HPV vaccine was 60.9% and 68.7% among women with CIN2 and CIN3, respectively, indicating that vaccination would have an impact both in HIV-negative and HIV-positive South African women, although it will not provide full protection in preventing HPV infection and cervical cancer lesions.
Highlights
Human immunodeficiency virus (HIV) infection is highly predominant in Africa
Our study aims at investigating the distribution of human papillomavirus (HPV) genotypes among HIV-positive and HIV-negative women with cervical intraepithelial lesions from Eastern Cape, South Africa
We observed a significantly higher prevalence of HPV and multiple HPV infections in HIV-positive compared to HIV-negative women with cervical intraepithelial lesions
Summary
Approximately 25.7 million people live with HIV infection, of which 80% (20.7 million) reside in Eastern and Southern Africa, as reported in 2019 [1,2]. HIV prevalence is estimated to be 19.0% among women aged 15–49 years [2,3]. South Africa, the prevalence of HIV infection for adult women aged 15–49 years ranges from 12.6% to 27.0%, with high rates observed in Kwazulu-Natal province (27.0%), Free. South Africa ranked as the country with the fourth highest number of cervical cancer cases among HIVpositive women (63.4%) in 2018 [6]. The incidence rate of cervical cancer was estimated to be 506 per 10,000 person-years among HIV-positive South African women in 2017 [7].
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