Associations of human papillomavirus (HPV) genotypes and related risk factors in a cohort of women living with HIV in a Brazilian countryside city

Women living with HIV (WLHIV) are prone to harbor several high-risk human papillomavirus (HR-HPV) genotypes and to develop cervical cancerous lesions. Data on HPV prevalence in these women are needed to inform immunization programs, especially in Asia where few data are available. We conducted a systematic review and meta-analysis to estimate the prevalence of HPV and HR-HPV cervical infection in WLHIV in Asia and identify possible sources of heterogeneity for HR-HPV carriage. Pooled prevalence and its 95% confidence interval (95CI) were estimated using the inverse-variance weighting method. Linear regression weighted on study size was used to identify sources of heterogeneity. Among 7834 WLHIV (40 studies), the prevalence of HPV infection was 42.6% (95CI, 38.2% to 47.1%), and 34.6% (95CI, 30.3% to 39.1%) harbored HR-HPV genotypes, with significant heterogeneity across countries. In India, Thailand, and China, HPV-16 was the most frequent genotype (10.3%), followed by HPV-52 (5.4%), HPV-58 (5.0%), HPV-18 (4.1%), and HPV-33 (3.3%). In these women, most of whom were receiving antiretroviral therapy, we did not identify determinants of heterogeneity for HR-HPV infection. Our results underline the need for immunization programs based on nonavalent or new generation vaccines to prevent cervical cancer in WLHIV in Asia.

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Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

Papillomavirus Research ◽

10.1016/j.pvr.2018.08.002 ◽

2018 ◽

Vol 6 ◽

pp. 15-21 ◽

Cited By ~ 3

Author(s):

Michelle S. Cespedes ◽

Minhee Kang ◽

Erna Milunka Kojic ◽

Triin Umbleja ◽

Catherine Godfrey ◽

...

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Sustained Response ◽

Women Living With Hiv ◽

Quadrivalent Hpv Vaccine ◽

Living With Hiv ◽

Hiv 1

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Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053636 ◽

2018 ◽

Vol 95 (2) ◽

pp. 140-144 ◽

Cited By ~ 1

Author(s):

Qian Wang ◽

Xiaomeng Ma ◽

Xiaosong Zhang ◽

Jason J Ong ◽

Jun Jing ◽

...

Keyword(s):

Logistic Regression ◽

Human Papillomavirus ◽

Cervical Intraepithelial Neoplasia ◽

Sexually Transmitted Infections ◽

Associated Factors ◽

Intraepithelial Neoplasia ◽

Multivariate Logistic Regression ◽

Sexually Transmitted ◽

Women Living With Hiv ◽

Living With Hiv

ObjectiveWomen living with HIV (WLHIV) face disproportionately higher risks of acquiring human papillomavirus (HPV) compared with HIV negative counterparts. We aimed to investigate the prevalence of HPV in WLHIV in Chinese hospital setting and identify associated factors to the progression of late-stage cervical intraepithelial neoplasia (CIN2+) in this population.MethodThis retrospective study collected data from 183 WLHIV on antiretroviral treatment (ART), based on reproductive health questionnaires. Gynaecological examination results including serum (for HIV viral load, CD4 T-cell count, hepatitis B infections, syphilis) and vaginal swabs for common bacterial sexually transmitted infections (STIs). Multivariate-logistic regression was applied to analyze the contributing factors to CIN2+.ResultsHIV coinfection with other Sexually Transmitted Infections (STIs) were observed in 99 participants (54.1%, (99/183)). HPV (43.7% (80/183)) was the most prevalent STI. The three most prevalent HPV subtypes were all high-risk HPV (HR-HPV), including HPV52 (33.8% (27/80)), HPV58 (21.3% (17/80)) and HPV33 (13.75% (11/80)). About a third (37.5%, 30/80) of women with HPV had HR-HPV. Multiple HPV coinfections were common in HIV-HPV coinfected women (41.3%, 33/80). Cytological examinations revealed that 77.5% (62/80) HPV+ women had detectable cervical lesions. In comparison, only 4.9% (5/103) HPV negative womenwith Atypia and 1.0% (1/103) with CIN1 were diagnosed. Multivariate logistic regression revealed that HPV16 (OR=19.04, 2.53 to 122.92; p=0.004) and HPV18 (OR=11.54, 1.45 to 91.64; p=0.021) infections were significantly associated with CIN2+ in HIV-HPV coinfected women.ConclusionA high prevalence of HPV was found in women on ART. HPV16/18 infection are strong associated factors to CIN2+ in HIV-HPV coinfected women.

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Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04222-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Agnes Napyo Kasede ◽

Thorkild Tylleskär ◽

David Mukunya ◽

Josephine Tumuhamye ◽

Grace Ndeezi ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Home Delivery ◽

Northern Uganda ◽

Adjusted Risk ◽

Women Living With Hiv ◽

Living With Hiv ◽

At Home

Abstract Background Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker). Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home. Conclusion Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.

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Diagnostic value of human papillomavirus (HPV) 16 and HPV18 viral loads for the detection of high-grade cervical intraepithelial neoplasia (CIN2+) in a cohort of African women living with HIV

Journal of Clinical Virology ◽

10.1016/j.jcv.2018.01.006 ◽

2018 ◽

Vol 99-100 ◽

pp. 79-83 ◽

Cited By ~ 3

Author(s):

Michel Segondy ◽

Jean Ngou ◽

Helen Kelly ◽

Tanvier Omar ◽

Olga Goumbri-Lompo ◽

...

Keyword(s):

Human Papillomavirus ◽

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

Diagnostic Value ◽

African Women ◽

High Grade ◽

Hpv 16 ◽

Viral Loads ◽

Women Living With Hiv ◽

Living With Hiv

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Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1456 ◽

2020 ◽

Author(s):

Cynthia Firnhaber ◽

Avril Swarts ◽

Vuyokazi Jezile ◽

Masango Mulongo ◽

Bridgette Goeieman ◽

...

Keyword(s):

Cervical Cancer ◽

Human Immunodeficiency Virus ◽

Human Papillomavirus ◽

Hpv Vaccination ◽

High Grade ◽

Double Blind ◽

Women Living With Hiv ◽

Immunodeficiency Virus ◽

Living With Hiv ◽

Intraepithelial Lesions

Abstract Background Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. Methods We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. Results Participant characteristics included median age of 39 years and median CD4 count 489 cells/μL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87–1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. Conclusions This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV.

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