Abstract
BackgroundThere is limited data in Ghana on the epidemiology of HPV and cervical neoplasia and their associations with HIV. This study aimed to compare among HIV-1 seropositive and HIV-seronegative Ghanaian women: (1) the prevalence, genotype distribution and risk factors associated with cervical HPV infection; and (2) the prevalence and risk factors associated with abnormal cervical cytology.MethodsA comparative frequency-matched study was conducted in a systematic sample of women aged ≥18 years attending HIV and general outpatient clinics in Cape Coast Teaching Hospital, Ghana. Participants were interviewed and cervical samples collected for HPV genotyping (Seegene Anyplex-II HPV28) and cytological testing.ResultsOverall, 333 women were recruited, 163 HIV-1 seropositive and 170 HIV-seronegative women of mean age 43.8 years (SD ±9.4)) and 44.3 years (SD ±12.8), respectively. The prevalence of 14 high-risk (hr) HPV genotypes was higher among HIV-1 seropositive women (65.6% vs. 30.2%, P < 0.0001), as was proportion with multiple hr.-HPV infections (60.6% vs. 21.3%, P < 0.0001). HPV35 was the most prevalent hr.-HPV genotype in both groups (11.9% and 5.3%). The main factors associated with hr.-HPV infection were age for HIV-positive women and circumcision status of main sexual partner for both HIV-negative and positive women.Abnormal cervical cytology prevalence was higher among HIV-1 seropositive women (any SIL: 14.1% vs. 1.2%, P < 0.0001; low-grade SIL [LSIL]: 4.9% vs. 0.6%, P = 0.02; high-grade SIL: 1.8% vs. 0%, P = 0.07). Among HIV-1 seropositive women, number of pregnancies and CD4+ cell count were associated with LSIL+ cytology. There was strong association between LSIL+ abnormalities and HPV35 (aOR = 4.7, 95%CI: 1.3–17.7, P = 0.02).ConclusionsHIV-1 infected women bear significant burden of HPV infection and related disease. Prevention and screening programmes should be specifically deployed for this population in Ghana.
Highlights
There is limited data in Ghana on the epidemiology of human papillomavirus (HPV) and cervical neoplasia and their associations with Human immunodeficiency virus (HIV)
The objectives of this study were to compare between HIV-1 sero-positive and HIV sero-negative women in the Cape Coast Metropolis of Ghana: (1) the prevalence, genotype distribution and risk factors associated with HPV infection, and (2) the prevalence and risk factors associated with abnormal cervical cytology (ASCUS+)
Study participants A total of 333 (163 HIV-1 seropositive and 170 HIVseronegative) women were recruited between July and December 2014
Summary
Persistence of hr.-HPV in the transformation zone of about 10% of infected persons may lead over time to squamous intraepithelial lesions (SIL) or cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC). HIV increases the risk of HPV persistence and development of associated cervical lesions [3]. Low CD4+ T-lymphocyte counts may increase the risk of recurrence [4, 5], whilst higher CD4+ cell counts may promote HPV clearance, highlighting the role of immunity in the development of cervical disease [6]. Improved survival among women living with HIV taking ART increases potential exposure time and may lead to higher cancer rates, underscoring the need for specific screening and management programmes in this high-risk population
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