Prevalence of high-risk HPV genotypes in sub-Saharan Africa based on Human immunodeficiency virus status: a 20-year systematic review.

This review assessed the rate of high-risk Human papillomavirus (HPV) infection among women living in sub-Saharan Africa. It also determined the prevalence of high-risk HPV (hrHPV) among human immunodeficiency virus seropositive (HIV+) and seronegative (HIV-) women in sub-Saharan Africa, pre-and post-year 2010. In this systematic review, Google Scholar, PubMed Central, and EMBASE databases were searched to identify cohort and case-controlled studies that investigated the relationship between HIV and HPV infections. Database searches yielded 17 studies published between 1999 and 2018. In the general population, the prevalence of any HPV/multiple HPV infection was higher among HIV+ (53.6%/22.6%) than among HIV- women (26.5%/7.3%) with OR' 3.22/3.71, 95% confidence interval: 3.00-3.42/2.39- 5.75, p< 0.001). The prevalent HPV genotypes among HIV+ and HIV- women diagnosed with invasive cervical cancer (ICC) were HPV-16/18 and 45. The prevalence of HPV 16, 18 and 45 was lower in 1999-2010 (3.8%, 1.7% and 0.8%) than in 2011-2018 (19.1%, 6.0%, and 3.6%, respectively). Among women diagnosed of ICC, HIV+ women had higher prevalence of HPV-56, 31 and 51 (7.3%, 5.3% and 3.3%) than HIV- women (1.3%, 2.2% and 0.4%, p< 0.001, p= 0.050 and 0.013, respectively). In conclusion, this paper reveals that the prevalence of HPV infection, multiple HPV infection and non-vaccine HPV types were higher among HIV+ women than in HIV- women in sub-Saharan Africa. Although HIV infection influences the distribution of HPV types, this study suggests that cervical cancer incidence in sub-Saharan Africa is majorly driven by the prevalence of vaccine hrHPVs, especially HPV 16 and 18.