Bariki Mchome1, Ditte S Linde2, Rachel Manongi3, Marianne Waldstroem4, Thomas Lftner5, Chunsen Wu6, Julius Mwaisalage7, Vibeke Rasch6, Susanne K Kjaer8. 1. Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College, Kilimanjaro, United republic of Tanzania. Electronic address: Barikimchome@gmail.com. 2. Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Public Health, University of Southern Denmark, Esbjerg, Denmark. 3. Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, United republic of Tanzania. 4. Department of Pathology, Vejle Hospital, Vejle, Denmark. 5. Department of Experimental Virology, Tubingen University, Tubingen, Germany. 6. Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 7. Department of Cancer Prevention Services, Ocean Road Cancer Institute, Dar-es-Salaam, United Republic of Tanzania. 8. Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Denmark.
Abstract
BACKGROUND: The causative role of human papillomavirus (HPV) in cervical carcinogenesis is well established. Despite this, prospective studies examining high-risk (HR) HPV acquisition among adult women in HIV prevalent settings are limited. METHODS: We conducted a prospective study among women (25-60 years) attending cervical cancer screening in Tanzania. Cervical specimens were obtained at enrolment and follow-up and tested for HPV (Hybrid Capture 2/LiPaExtra). Participants were interviewed on lifestyle and HIV testing was performed. RESULTS: Among 3805 eligible women, 3074 (80.8%) attended follow-up (median time between the two examinations: 17.3 months). Of these, 307 had missing HPV results at either enrolment or follow-up, leaving 2767 women in the study. Among 2253 women initially HR HPV negative, 184 acquired HR HPV (incidence: 54.5 per 1000 person-years (95% CI:47.1-62.9)). The incidence was 75.2 per 1000 person-years (95% CI:54.5-103.7) among HIV positive and 50.9 per 1000 person-years (95% CI:43.3-60.0) among HIV negative. HPV52 and HPV16 were the most frequently acquired types. In multivariable regression analysis, factors associated with increased odds of HPV acquisition included HIV positivity, low CD4 count, younger age, and multiple sex partners. CONCLUSION: HPV acquisition was higher among HIV positive than HIV negative women, especially among women with low CD4 count. Improvement of immune status among HIV positives may decrease HPV acquisition. Given the pattern of HR HPV types acquired, nonavalent HPV vaccination should be considered.
BACKGROUND: The causative role of human papillomavirus (HPV) in cervical carcinogenesis is well established. Despite this, prospective studies examining high-risk (HR) HPV acquisition among adult women in HIV prevalent settings are limited. METHODS: We conducted a prospective study among women (25-60 years) attending cervical cancer screening in Tanzania. Cervical specimens were obtained at enrolment and follow-up and tested for HPV (Hybrid Capture 2/LiPaExtra). Participants were interviewed on lifestyle and HIV testing was performed. RESULTS: Among 3805 eligible women, 3074 (80.8%) attended follow-up (median time between the two examinations: 17.3 months). Of these, 307 had missing HPV results at either enrolment or follow-up, leaving 2767 women in the study. Among 2253 women initially HR HPV negative, 184 acquired HR HPV (incidence: 54.5 per 1000 person-years (95% CI:47.1-62.9)). The incidence was 75.2 per 1000 person-years (95% CI:54.5-103.7) among HIV positive and 50.9 per 1000 person-years (95% CI:43.3-60.0) among HIV negative. HPV52 and HPV16 were the most frequently acquired types. In multivariable regression analysis, factors associated with increased odds of HPV acquisition included HIV positivity, low CD4 count, younger age, and multiple sex partners. CONCLUSION:HPV acquisition was higher among HIV positive than HIV negative women, especially among women with low CD4 count. Improvement of immune status among HIV positives may decrease HPV acquisition. Given the pattern of HR HPV types acquired, nonavalent HPV vaccination should be considered.