HPV Type Distribution and Cervical Cytology among HIV-Positive Tanzanian and South African Women

Joke A M Dols,Wim G V Quint,Gregor Reid,Joelle M Brown,Tj Romke Bontekoe,Mathilde E Boon,Hugo Tempelman

doi:10.5402/2012/514146

Abstract

Background. There are limited data on high-risk human papillomavirus (hr-HPV) genotypes among HIV-positive women in Africa, and little is known about their relationship with cervical cytology in these populations. Methods. We conducted a cross-sectional study among 194 HIV-positive women (143 from Tanzania, and 51 from South Africa) to evaluate HPV genotypes among HIV-positive women with normal and abnormal cytology. Cervical samples were genotyped for HPV types, and slides were evaluated for atypical squamous cell changes according to the Bethesda classification system. Results. Prevalence of high grade squamous intraepithelial dysplasia (HSIL) was 9%. Overall, more than half (56%) of women were infected with an hr-HPV type; 94% of women with HSIL (n = 16), 90% of women with LSIL (n = 35), and 42% of women within normal limits (WNL) (n = 58) tested positive for hr-HPV. Overall, the most prevalent hr-HPV subtypes were HPV16 (26%) and HPV52 (30%). Regional differences in the prevalence of HPV18 and HPV35 were found. Conclusion. Regional differences in HPV genotypes among African women warrant the need to consider different monitoring programmes for cervical preneoplasia. HPV-based screening tests for cervical preneoplasia would be highly inefficient unless coupled with cytology screening of the HPV-positive sample, especially in HIV-positive women.

Highlights

Cervical carcinoma is the second most prevalent cancer in the world, and the most common female cancer in subSaharan Africa
109 (56%) women tested positive for high-risk human papillomavirus (hr-HPV) (Table 2); 80 (56%) Tanzanian women and 29 (57%) South African women
This study found that hr-HPV genotypes not included in the currently licensed HPV vaccines are highly prevalent in HIV-positive women from Tanzania and South Africa

Summary

Introduction

Cervical carcinoma is the second most prevalent cancer in the world, and the most common female cancer in subSaharan Africa. The basis for selecting these genotypes was their prevalence in Europe and North America [1] The relevance of these genotypes to women in other parts of the world has been questioned, with a study of HPV genotypes in women in 38 countries including some in Central America, Africa, Asia, and Oceania [2]. There are limited data on high-risk human papillomavirus (hr-HPV) genotypes among HIV-positive women in Africa, and little is known about their relationship with cervical cytology in these populations. We conducted a crosssectional study among 194 HIV-positive women (143 from Tanzania, and 51 from South Africa) to evaluate HPV genotypes among HIV-positive women with normal and abnormal cytology. HPV-based screening tests for cervical preneoplasia would be highly inefficient unless coupled with cytology screening of the HPV-positive sample, especially in HIV-positive women

Methods

Results

Conclusion