Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women.

Yan Tong,Maina Titus,Darron R Brown,Patrick J Loehrer,Stephen Kiptoo,Nelson Wong,Philip Tonui,Omenge Orang’o,Aaron Ermel,Kapten Muthoka

doi:10.1177/2050312120945138

Abstract

Objectives:Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia.Methods:Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic and behavioral characteristics.Results:HIV-infected women were older and less likely to be married and to own a home and had more lifetime sexual partners than HIV-uninfected women. All HIV-infected women were receiving anti-retroviral therapy at enrollment and had satisfactory CD4 cell counts and HIV viral loads. One- and two-year persistent human papillomavirus detection was significantly associated with HIV infection for any human papillomavirus, high-risk human papillomavirus, International Agency for the Research on Cancer-classified high-risk human papillomavirus, and non-oncogenic “low-risk” human papillomavirus.Conclusion:Persistent detection of oncogenic and non-oncogenic human papillomavirus was strongly associated with HIV infection in Kenyan women with re-constituted immune systems based on satisfactory CD4 cell counts. In addition to HIV infection, factors associated with an increased risk of human papillomavirus persistence included a higher number of lifetime sex partners. Factors associated with decreased risk of human papillomavirus persistence included older age and being married. Further studies are needed to identify the immunological defects in HIV-infected women that allow human papillomavirus persistence, even in women receiving effective anti-retroviral therapy. Further studies are also needed to determine the significance of low-risk human papillomavirus persistence in HIV-infected women.

Highlights

Analysis at the type-specific detection records level demonstrated that persistent detection of any HPV, HR-HPV, and International Agency for the Research on Cancer (IARC) HR-HPV, and LR-HPV types were significantly higher in HIV-infected women compared to HIV-uninfected women
Analysis at the participant level demonstrated that 1- and 2-year persistent detection of any HPV, HR-HPV, and IARC HR-HPV, and LR-HPV types were significantly higher in HIV-infected women compared to HIV-uninfected women
HPV persistence was examined in this longitudinal study of Kenyan women, approximately half of whom were HIV-infected, receiving effective anti-retroviral therapy (ART), and had re-constituted immune systems based on satisfactory CD4 cell counts

Summary

Introduction

HR-HPV infections are common, but only a small percentage of women will develop cervical cancer; persistent detection of HR-HPV over a 1- or 2-year period is associated with an increased risk of cancer.[9,10,11,12,13] In addition, women who are HIV-infected have a higher incidence of HR-HPV infection, pre-cancerous cervical lesions, and cervical cancer compared to HIV-uninfected women.[14,15,16,17,18,19,20,21,22,23,24,25] progress is being made, the HIV epidemic continues in Kenya with a prevalence of approximately 6.9% among women aged 15 to 64 years.[26]

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