Variability of high risk HPV genotypes among HIV infected women in Mwanza, Tanzania- the need for evaluation of current vaccine effectiveness in developing countries.

Fridolin Mujuni,Mariam M Mirambo,Peter Rambau,Stephen E Mshana,Christa Kasang,Muller Andreas,Dismas Matovelo,Korn Klaus,Mtebe Majigo

doi:10.1186/s13027-016-0097-2

Abstract

BackgroundHigh risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania.MethodsA cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11.ResultsA total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005)ConclusionSignificant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic.

Highlights

High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer
We document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) and associated factors among Human Immunodeficiency Virus (HIV)- infected women at Bugando Medical Centre, Mwanza-Tanzania underscoring the importance of focused control strategies to prevent cervical cancer in developing countries
Socio-demographic and clinical information The study included all HIV infected women aged >18 years attending the care and treatment clinic (CTC) during the study period while excluding women who underwent wedge resection of the cervix and those with missed Cluster of Differentiation type 4 (CD4) counts within 3 months of specimen collection

Summary

Introduction

High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. Human papillomavirus (HPV) is a very common sexually transmitted infection which is acquired through body fluids and skin-to-skin contact [1] It has been known as the causal agent of cervical cancer [2]. In HIV infected women the risk of acquiring HPV is even higher due to immune suppression caused by HIV infection which has the same epidemiological pattern as HPV in sub-Saharan Africa [5, 6] In most of these cases infection with multiple genotypes has been found to predominate [5, 7,8,9,10,11,12,13]. Vaccines for HPV are available in some countries and have been found to be effective in reducing infection and its associated consequences [16]

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