Abstract
BackgroundWe conducted in 2018 a descriptive, quantitative, population-based, cross-sectional survey estimating the prevalence of cervical high-risk human papillomavirus (HR-HPV) infection and associated risk factors among adult women living in N’Djamena, Chad.MethodsFive of the 10 districts of N’Djamena were randomly selected for inclusion. Peer educators contacted adult women in community-churches or women association networks to participate in the survey and come to the clinic for women’s sexual health “La Renaissance Plus”, N’Djamena. Medical, socio-demographical and behavioral informations were collected. HPV DNA was detected and genotyped in endocervical swab using Anyplex II HPV28 genotyping test (Seegene, Seoul, South Korea).Results253 women (mean age, 35.0 years; range, 25–65) including 3.5% of HIV-positive women were prospectively enrolled. The prevalence of HPV infection was 22.9%, including 68.9% of HR-HPV infection and 27.6% being infected with multiple genotypes, providing a total HR-HPV prevalence of 15.8% (95% CI%: 11.3–20.3). The most prevalent HR-HPV genotypes were HPV-58, HPV-35, HPV-56, HPV-31, HPV-16, HPV-45, HPV-52 and HPV-18. HPV types targeted by the prophylactic Gardasil-9 vaccine were detected in nearly 70% (67.5%) and HPV-58 was the most frequently detected. HIV infection was a risk factor strongly associated with cervical infection with any HPV [adjusted Odds ratio (aOR): 17.4], multiple types of HPV (aOR: 8.9), HR-HPV (aOR: 13.2) and cervical infection with multiple HR-HPV (aOR: 8.4).ConclusionThese observations highlight the unsuspected high burden of cervical HR-HPV infection in Chadian women, and point the potential risk of further development of HPV-associated cervical precancerous and neoplastic lesions in a large proportion of women in Chad. The high rate of preventable Gardasil-9 vaccine genotypes constitutes the rationale for introducing primary vaccine prevention against cervical cancer in young female adolescents living in Chad.
Highlights
Human papillomavirus (HPV) infection is the most common viral sexually transmitted infection (STI) worldwide and high-risk (HR)-HPV genotypes are responsible for 5.2% of all cancers worldwide, 2.2% of cancers in developed countries and 7.7% of all cancers in developing countries [1,2,3]
The prevalence of HPV infection was 22.9%, including 68.9% of high-risk human papillomavirus (HR-HPV) infection and 27.6% being infected with multiple genotypes, providing a total HR-HPV prevalence of 15.8%
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Human papillomavirus (HPV) infection is the most common viral sexually transmitted infection (STI) worldwide and high-risk (HR)-HPV genotypes are responsible for 5.2% of all cancers worldwide, 2.2% of cancers in developed countries and 7.7% of all cancers in developing countries [1,2,3]. Primary prevention of cervical cancer by vaccinating young girls at 10 to 14 years of age with Gardasil-9 vaccine prior sexual onset would protect them theoretically against most of the cervical HR-HPV infections [11, 12]. This primary prevention, combined with other prevention strategies (secondary and tertiary prevention) already in place in sub-Saharan Africa would overcome the high burden of cervical cancer in this continent [7, 13]. We conducted in 2018 a descriptive, quantitative, population-based, cross-sectional survey estimating the prevalence of cervical high-risk human papillomavirus (HR-HPV) infection and associated risk factors among adult women living in N’Djamena, Chad
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