The Distribution of Sexually-Transmitted Human Papillomaviruses in HIV Positive and Negative Patients in Zambia, Africa

Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA. <>
BMC Infectious Diseases (Impact Factor: 2.61). 02/2007; 7(1):77. DOI: 10.1186/1471-2334-7-77
Source: PubMed


Human Papillomaviruses (HPV) are double-stranded DNA viruses, considered to be the primary etiological agents in cervical intraepithelial neoplasias and cancers. Approximately 15-20 of the 40 mucosal HPVs confer a high-risk of progression of lesions to invasive cancer. In this study, we investigated the prevalence of sexually transmitted HPVs in Human Immunodeficiency Virus (HIV) positive and negative patients in Zambia, Africa. The rate of high-risk HPV genotypes worldwide varies within each country. Thus, we sought to investigate the rates of HPV infection in sub-Saharan Africa and the potential role of HIV in affecting the HPV genotype distribution.
This retrospective cross-sectional study reports findings on the association and effects of HIV on HPV infections in an existing cohort of patients at University Teaching Hospital (UTH) Lusaka, Zambia. The objective of this study was to assess HPV prevalence, genotype distribution and to identify co-factors that influence HPV infection. Polymerase chain reaction (PCR) with two standard consensus primer sets (CpI/II and GP5+/6+) was used to test for the presence of HPV DNA. Primers specific for beta-actin were used to monitor DNA quality. Vaginal lavage samples, collected between 1998-1999 from a total of 70 women, were part of a larger cohort that was also analyzed for HIV and human herpesvirus infection. Seventy of the samples yielded usable DNA. HIV status was determined by two rapid assays, Capillus and Determine. The incidence of HIV and HPV infections and HPV genotype distributions were calculated and statistical significance was determined by Chi-Squared test.
We determined that most common HPV genotypes detected among these Zambian patients were types 16 and 18 (21.6% each), which is approximately three-fold greater than the rates for HPV16, and ten-fold greater than the rates for HPV18 in the United States. The worldwide prevalence of HPV16 is approximately 14% and HPV18 is 5%. The overall ratio of high-risk (HR) to low-risk (LR) HPVs in the patient cohort was 69% and 31% respectively; essentially identical to that for the HR and LR distributions worldwide. However, we discovered that HIV positive patients were two-times as likely to have an HR HPV as HIV negative individuals, while the distribution of LR HPVs was unaffected by HIV status. Interestingly, we observed a nine-fold increase in HPV18 infection frequency in HIV positive versus HIV negative individuals.
The rate of oncogenic HPVs (type 16 and 18) in Zambia was much higher than in the U.S., potentially providing an explanation for the high-rates of cervical cancer in Zambia. Surprisingly, we discovered a strong association between positive HIV status and the prevalence of HR HPVs, and specifically HPV18.

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    • "compared with that reported in Europe, America and some African populations with varied stages of CIN [14, 25]. These rates were also lower than others reported from sub-Saharan Africa, which ranged between 18% and 58% for hr-HPV genotypes 16 and 18, respectively [5, 19, 21] , which HPV vaccines target. The top five hr-HPV genotypes reported among the control group in this study were 58, 35, 31, 52 and 39 in descending order. "
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    ABSTRACT: Objectives: To describe the burden of HPV infection among women living with HIV and non-infected women in Ghana. Methods: A case control study involving 107 women living with HIV aged between 18-59 years (cases) and 100 non-HIV-infected apparently healthy women (controls) were recruited from the Kumasi South Hospital, from July to December, 2014. Cervicovaginal swabs were taken from study participants to characterise 28 high and low-risk HPV genotypes using a multiplex real-time PCR. Results: The overall mean age for the participants was 40.10±9.76 years. The prevalence of high risk (hr)-HPV genotypes was significantly higher among the cases than the controls (77.4% versus 41.6%, p< 0.0001). Overall, HPV 58 and 54 were the most predominant high risk (18.8%) and low risk (15.0%) genotypes detected. The two most common hr-HPV genotype isolates were 58 (18.8%) and 35 (15.9%) with 58 being the most prevalent among age group 35-44 years compared to hr-HPV 16, 18, 35 and 45, found predominantly among 18-34 age group. Conclusions: Significant variations exist in HPV genotypes among HIV-infected and uninfected women. This article is protected by copyright. All rights reserved.
    Full-text · Article · Nov 2015 · Tropical Medicine & International Health
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    • "The risk of recurrence or progression of cervical lesions is 4–5 times higher in women living with HIV [8]. Infection with one of the 15 HR-HPV genotypes is significantly more common in HIV-infected women [9], while the distribution of low-risk oncogenic HPV is not affected by HIV status [10]. This reflects a higher propensity of HR-HPV in determining persistent infections [11]. "
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    ABSTRACT: Cervical cancer is the first female cancer in Lao PDR, a low-income country with no national screening and prevention programs for this human papillomavirus (HPV) associated pathology. HIV-infected women have a higher risk of persistent oncogenic HPV infection.The purpose of this study was to determine the knowledge, awareness and attitudes about cervical cancer among Lao women attending or not an HIV treatment center, in order to understand if this attendance had offered an opportunity for information and prevention. A cross-sectional case-control survey was conducted in three provinces of Lao PDR, Vientiane, Luang Prabang and Savannakhet. Cases were 320 women aged 25 to 65, living with HIV and followed in an HIV treatment center. Controls were 320 women matched for age and place of residence, not attending an HIV treatment center. Cases had a greater number of sexual partners and used condoms more often than controls. Only 36.6% of women had consulted a gynecologist (47.5% among cases and 25.6% among controls, p < 0.001) and 3.9% had benefited from at least one Pap smear screening (5.6% cases and 2.2% controls, p = 0.02). The average knowledge score was 3.5 on a 0 to 13 scale, significantly higher in cases than in controls (p < 0.0001). Despite having a lower education level and economic status, the women living with HIV had a better knowledge about cervical cancer and were more aware than the controls of the risk of developing such a cancer (35.9% vs. 8.4%, p = 0.0001). The main source of information was healthcare professionals. The main reasons for not undergoing Pap smear were the absence of symptoms and the default of medical injunction for cases, the lack of information and ignorance of screening usefulness for controls. In Lao PDR, routine consultation in HIV treatment centers is not enough harnessed to inform women of their high risk of developing cervical cancer, and to perform screening testing and treatment of precancerous lesions. Implementing this cost-effective strategy could be the first step toward a national prevention program for cervical cancer.
    Full-text · Article · Mar 2014 · BMC Cancer
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    • "The observed rise in cervical cancer rate has been linked to the chronic deviations in the immune systems due to HIV infection [3-5]. The impaired cell mediated immunity due to HIV infection results in the body’s inability to clear high risk (hr) human papilloma virus (HPV) leading to the persistence of the virus in the cervix and eventual transformation of the infected cervical cells to precancerous and cancerous lesions [6]. With the diverse HIV epidemic in sub-Saharan Africa, it is essential to consider how it may affect HPV related cervical diseases including cervical cancer [7,8]. "
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    ABSTRACT: The expected reduction in cervical cancer incidence as result of increased access to antiretroviral therapy is yet to be seen. In this study we investigated the effect of HIV infection and treatment on high-risk (hr) human papilloma virus (HPV) prevalence and distribution. Cervical cells from 515 (220 HIV positive and 295 HIV negative) women, recruited during community cervical cancer screening programme in states of Ogun and Lagos and at the cervical cancer screen clinic, Nigerian Institute of Medical Research Lagos were evaluated for the presence of 13 hr HPV genotypes by polymerase chain reaction based assay. The prevalence of high-risk HPV was 19.6% in the studied population. HPV 16 (3.9%), 35(3.5%), 58(3.3%) and 31(3.3%) were the most common hr HPV infections detected. We observed that the prevalence of hr HPV was higher in HIV positives (24.5%) than 15.9% in HIV negative women (OR = 1.7; 95% CI 1.1-2.7). A multivariate logistic regression analysis showed a lower hr HPV prevalence in HIV positive women on antiretroviral drugs (OR = 0.4; 95% CI: 0.3-0.5) and with CD4 count of 500 and above (OR = 0.7; 95% CI 0.5-0.8). A higher prevalence of hr HPV was also noted in HIV positive women with CD4 count < 200 cells/mm3 (OR = 2.4; 95% CI: 1.7-5.9). HPV 16, 35, 58 and 31genotypes were the most common hr HPV infection in our study group, which could be regarded as high risk general population sample; with higher prevalence of HPV 16 and 35 in HIV positive than in HIV negative women. The use of antiretroviral drugs was found to be associated with a lower prevalence of hr HPV infection, compared to those not on treatment. This study raises important issues that should be further investigated to enable the development of robust cervical cancer prevention and control strategies for women in our setting.
    Full-text · Article · Jan 2014 · Virology Journal
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