Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

Brandon L. Guthrie; Anne F. Rositch; Joy Alison Cooper; Carey Farquhar; Rose Bosire; Robert Choi; James Kiarie; Jennifer S. Smith

doi:10.1136/sextrans-2019-054052

Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

Brandon L. Guthrie, Anne F. Rositch, Joy Alison Cooper, Carey Farquhar, Rose Bosire, Robert Choi, James Kiarie, Jennifer S. Smith

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objective HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. Methods A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. Results Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. Conclusion HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.

Original language	English (US)
Pages (from-to)	457-463
Number of pages	7
Journal	Sexually transmitted infections
Volume	96
Issue number	6
DOIs	https://doi.org/10.1136/sextrans-2019-054052
State	Published - Sep 1 2020

Keywords

HIV
HPV
cervical cytology
cervical neoplasia
women

ASJC Scopus subject areas

Infectious Diseases
Dermatology

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10.1136/sextrans-2019-054052

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@article{9b8b519ea7354f9fb4e802467edb9cc9,

title = "Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya",

abstract = "Objective HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. Methods A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. Results Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. Conclusion HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.",

keywords = "HIV, HPV, cervical cytology, cervical neoplasia, women",

author = "Guthrie, {Brandon L.} and Rositch, {Anne F.} and Cooper, {Joy Alison} and Carey Farquhar and Rose Bosire and Robert Choi and James Kiarie and Smith, {Jennifer S.}",

note = "Funding Information: Research support included National Institutes of Health (NIH) (R01 AI0684316 and R24 TW007988) from Fogarty International Center (FIC) through Vanderbilt University. In addition, CF received support from NIH (K24 AI087399), RB was a scholar at the University of Washington International AIDS Research and Training Program (IARTP) funded by FIC (D43 TW000007), and BG was supported by an NIH/FIC postdoctoral fellowship (3D43TW000007-22S1) and by an NIH/NIAID Career Development Award (K01AI098527). AFR was supported by an NIH/NICHD Career Development Award (K23HD071788). RC received support from the International Research Scientist Development Award (K01 TW008406). This publication was made possible with help from the University of Washington Center for AIDS Research (CFAR), an NIH-funded programme (P30 AI027757), and the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR) (P30 AI050410), which are supported by the following NIH institutes and centres: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI and NIA. Publisher Copyright: {\textcopyright} 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = sep,

day = "1",

doi = "10.1136/sextrans-2019-054052",

language = "English (US)",

volume = "96",

pages = "457--463",

journal = "Sexually transmitted infections",

issn = "1368-4973",

publisher = "BMJ Publishing Group",

number = "6",

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TY - JOUR

T1 - Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

AU - Guthrie, Brandon L.

AU - Rositch, Anne F.

AU - Cooper, Joy Alison

AU - Farquhar, Carey

AU - Bosire, Rose

AU - Choi, Robert

AU - Kiarie, James

AU - Smith, Jennifer S.

N1 - Funding Information: Research support included National Institutes of Health (NIH) (R01 AI0684316 and R24 TW007988) from Fogarty International Center (FIC) through Vanderbilt University. In addition, CF received support from NIH (K24 AI087399), RB was a scholar at the University of Washington International AIDS Research and Training Program (IARTP) funded by FIC (D43 TW000007), and BG was supported by an NIH/FIC postdoctoral fellowship (3D43TW000007-22S1) and by an NIH/NIAID Career Development Award (K01AI098527). AFR was supported by an NIH/NICHD Career Development Award (K23HD071788). RC received support from the International Research Scientist Development Award (K01 TW008406). This publication was made possible with help from the University of Washington Center for AIDS Research (CFAR), an NIH-funded programme (P30 AI027757), and the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR) (P30 AI050410), which are supported by the following NIH institutes and centres: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI and NIA. Publisher Copyright: © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/9/1

Y1 - 2020/9/1

N2 - Objective HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. Methods A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. Results Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. Conclusion HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.

AB - Objective HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. Methods A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. Results Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. Conclusion HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.

KW - HIV

KW - HPV

KW - cervical cytology

KW - cervical neoplasia

KW - women

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Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

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