Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa.

Admire Chikandiwa,Bernard Sawadogo,Michel Segondy,Helen Kelly,Pedro T Pisa,Helen A Weiss,Philippe Mayaud,On Behalf Of The Harp Study Group ,Jean Ngou,Lorna Gibson,Marie-Noelle Didelot,Sinead Delany-Moretlwe,Nicolas Meda

doi:10.1371/journal.pone.0196018

Abstract

ObjectiveTo report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV) and anogenital warts (AGW) among women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA), and to explore HIV-related factors associated with these outcomes.MethodsWe enrolled 1238 WLHIV (BF = 615; SA = 623) aged 25–50 years and followed them at three time points (6, 12 and 16 months) after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW.ResultsWomen in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p<0.001) and incident LR-HPV infection (BF: 25.8% vs. SA: 31.6%, p = 0.05). Prevalence of persistent LR-HPV was similar in the two countries (BF: 33.3% vs. SA: 30.4%; p = 0.54), as were prevalence and incidence of AGW (Prevalence: BF: 7.5% vs. SA: 5.7%; p = 0.21; Incidence: BF: 2.47 vs. SA: 2.33 per 100 person-years; p = 0.41). HPV6 was associated with incident AGW (BF: adjusted Hazard Ratio (aHR) = 4.88; 95%CI: 1.36–17.45; SA: aHR = 5.02; 95%CI: 1.40–17.99). Prevalent LR-HPV (BF: adjusted Odds Ratio [aOR = 1.86]; 95%CI: 1.01–3.41; SA: aOR = 1.75; 95%CI: 0.88–3.48); persistent LR-HPV (BF: aOR = 1.92; 95%CI: 0.44–8.44; SA: aOR = 2.81; 95%CI: 1.07–7.41) and prevalent AGW (BF: aOR = 1.53; 95%CI: 0.61–3.87; SA: aOR = 4.11; 95%CI: 1.20–14.10) were each associated with low CD4+ counts (i.e. <200 vs. >500 cells/μL). Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes.ConclusionLR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population.

Highlights

Anogenital human papillomavirus (HPV) infection is the most frequent sexually transmitted infection (STI) globally.[1]
Two-thirds of the participants were on antiretroviral therapy (ART) (BF: 68.6% in Burkina Faso (BF); 65.2% in South Africa (SA)) and this is because enrolment was stratified in the ratio of 2 ART users: 1 non-ART user
AAny Low Risk (LR)-HPV = HPV6/11/40/43/44/54/70/69/71/74; Adjusted Odds Ratio: Model 1 bIn Burkina Faso, associations with LR-HPV were adjusted for alcohol use, condom use and number of pregnancies cIn SA, associations with LR-HPV were adjusted for regular sex partner, number of pregnancies and number of lifetime sex partners; For Model 2: same adjustment as

Summary

Introduction

Anogenital human papillomavirus (HPV) infection is the most frequent sexually transmitted infection (STI) globally.[1] Low Risk (LR) HPV types 6 and 11 are the predominant causes of anogenital warts (AGW), a source of psychosocial distress,[2] and physical discomfort (including bleeding and itching).[3] Approximately 25% of AGW spontaneously regress,[3] but recurrence is common, resulting in high medical costs from repeated treatment.[4]. Some report that ART reduces incidence,[10] while other studies have shown that it does not reduce incidence.[7, 11]

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Conclusion