Abstract
Female sex workers (FSWs) have a notably high risk of acquiring human papillomavirus (HPV) infections. Relatively few studies address the type-specific prevalence and incidence of HPV among FSWs in sub-Saharan Africa. FSWs (n = 348) attending the Korogocho clinic in Nairobi, Kenya participated from August 2009 to March 2011. HPV DNA was detected using the SPF10-LiPA25 PCR assay. Baseline prevalence of HPV infection and cervical dysplasia were calculated, stratified by HIV-serostatus. Incidence rate (IR) of infection was calculated as number of new infections from baseline over person-months among 160 HPV-negative participants with complete 12-month follow-up. Baseline HPV prevalence was 23.6% for any HPV and 20.4% for high-risk HPV (hrHPV) types. Most prevalent types were HPV52 (10.1%), HPV35 (2.3%), and HPV51 (2.3%). A quarter (24%) of participants were HIV-positive. HPV prevalence was higher in HIV-positive (32.1%) than HIV-negative (20.8%) participants. hrHPV prevalence was higher in HIV-positive (27.4%) than HIV-negative (18.2%) women. During follow-up, HPV IR was 31.4 (95% CI: 23.8–41.5) for any HPV and 24.2 (95% CI: 17.9–32.8) for hrHPV types. HPV52 had the highest IR (6.0; 95% CI: 6.5–10.3). Overall HPV and hrHPV prevalence were lower than expected, but both prevalence and incidence were higher in HIV-positive than in HIV-negative women.
Highlights
Invasive cervical cancer (ICC) is the leading cause of cancer among women in Eastern Africa.[1]
100% of ICC are caused by high-risk human papillomavirus (HPV) infections.[3]
HPV types can be separated into two categories: high-risk types and low-risk types, based on their association with ICC.[8]
Summary
Invasive cervical cancer (ICC) is the leading cause of cancer among women in Eastern Africa.[1] More than 85% of the estimated 311,365 ICC deaths in 2018 occurred in low- and middle-income countries, where screening remains inadequate.[2] Nearly 100% of ICC are caused by high-risk (oncogenic) human papillomavirus (HPV) infections.[3] HIV-positive women have a significantly higher risk of HPV infection overall, International Journal of STD & AIDS 31(2). Multiple types of HPV infections, and HPV persistence than non-infected women.[4,5] HIV-positive women have higher rates of high-grade cervical precancer and ICC than HIV-negative women.[6,7]. HPV types can be separated into two categories: high-risk types (high-risk HPV [hrHPV]) and low-risk types (low-risk HPV [lrHPV]), based on their association with ICC.[8] Primary prevention of HPV infections through vaccination could reduce the burden of high-risk type HPV infections and associated cervical disease. There are currently three FDA-approved vaccines: the bivalent vaccine which protects against hrHPV types 16 and 18; the quadrivalent vaccine which protects against hrHPV types 16 and 189,10 and low-risk HPV types 6 and 11 (which cause genital warts); and the most recent nonavalent vaccine, which protects against 6, 11, 16, 18 and an additional five hrHPV types (31, 33, 45, 52, and 58).[11]
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