Date Published: March 23, 2017
Publisher: Public Library of Science
Author(s): Helen A. Kelly, Jean Ngou, Admire Chikandiwa, Bernard Sawadogo, Clare Gilham, Tanvier Omar, Olga Lompo, Sylviane Doutre, Nicolas Meda, Helen A. Weiss, Sinead Delany-Moretlwe, Michel Segondy, Philippe Mayaud, Charlotte Charpentier.
To describe associations of high-risk human papillomavirus (HR-HPV) with high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA).
Prospective cohort of WLHIV attending HIV outpatient clinics and treatment centres. Recruitment was stratified by ART status. Cervical HPV genotyping using INNO-LiPA and histological assessment of 4-quadrant cervical biopsies at enrolment and 16 months later.
Among women with CIN2+ at baseline, the prevalence of any HR-HPV genotypes included in the bi/quadrivalent (HPV16/18) or nonavalent (HPV16/18/31/35/45/52/58) HPV vaccines ranged from 37% to 90%. HPV58 was most strongly associated with CIN2+ (aOR = 5.40, 95%CI: 2.77–10.53). At 16-months follow-up, persistence of any HR-HPV was strongly associated with incident CIN2+ (aOR = 7.90, 95%CI: 3.11–20.07), as was persistence of HPV16/18 (aOR = 5.25, 95%CI: 2.14–12.91) and the additional HR types in the nonavalent vaccine (aOR = 3.23, 95%CI: 1.23–8.54).
HR-HPV persistence is very common among African WLHIV and is linked to incident CIN2+. HPV vaccines could prevent between 37–90% of CIN2+ among African WLHIV.
Women living with HIV (WLHIV) have a higher prevalence of genital high-risk human papillomavirus (HR-HPV) infection than the general population , are more likely to be infected with multiple HR types [2, 3] and have greater persistence of infection  and risk of cervical intraepithelial neoplasia (CIN) progression . WLHIV have been shown to be more commonly infected with types other than HPV16 or 18  and their high-grade cytological lesions are frequently attributed to types other than HPV16/18 .
Women living with HIV (WLHIV) in Burkina Faso and South Africa have a high prevalence, incidence and persistence of HR-HPV and correspondingly a high prevalence and incidence of cervical neoplasia. The high rates of HR-HPV found in both countries are similar to other studies in Sub Saharan Africa [1, 2, 15, 16]. The increased risk in the prevalence of HR-HPV and CIN2+ among women in South Africa compared to Burkina Faso may be explained by the less well controlled HIV disease (in terms of lower rates of ART adherence and HIV viral suppression) found among women in South Africa, as we reported elsewhere , as well as by other cofactors for HR-HPV and CIN2+, such as greater frequency of contraceptive use and smoking and higher prevalence of mucosal STIsobserved in this and other cohort of WLHIV [17–25].