Human papillomavirus prevalence, viral load and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa : a cross-sectional study

Moodley, Jennifer R., Constant, Deborah, Hoffman, Margaret, Salimo, Anna, Allan, Bruce, Rybicki, Edward P., Hitzeroth, Inga I., & Williamson, Anna-Lise (2009) Human papillomavirus prevalence, viral load and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa : a cross-sectional study. BMC Cancer, 9(275).

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Abstract

Background

Cervical cancer and infection with human immunodeficiency virus (HIV) are both important public health problems in South Africa (SA). The aim of this study was to determine the prevalence of cervical squamous intraepithelial lesions (SILs), high-risk human papillomavirus (HR-HPV), HPV viral load and HPV genotypes in HIV positive women initiating anti-retroviral (ARV) therapy.

Methods

A cross-sectional survey was conducted at an anti-retroviral (ARV) treatment clinic in Cape Town, SA in 2007. Cervical specimens were taken for cytological analysis and HPV testing. The Digene Hybrid Capture 2 (HC2) test was used to detect HR-HPV. Relative light units (RLU) were used as a measure of HPV viral load. HPV types were determined using the Roche Linear Array HPV Genotyping test. Crude associations with abnormal cytology were tested and multiple logistic regression was used to determine independent risk factors for abnormal cytology.

Results

The median age of the 109 participants was 31 years, the median CD4 count was 125/mm3, 66.3% had an abnormal Pap smear, the HR-HPV prevalence was 78.9% (Digene), the median HPV viral load was 181.1 RLU (HC2 positive samples only) and 78.4% had multiple genotypes. Among women with abnormal smears the most prevalent HR-HPV types were HPV types 16, 58 and 51, all with a prevalence of 28.5%. On univariate analysis HR-HPV, multiple HPV types and HPV viral load were significantly associated with the presence of low and high-grade SILs (LSIL/HSIL). The multivariate logistic regression showed that HPV viral load was associated with an increased odds of LSIL/HSIL, odds ratio of 10.7 (95% CI 2.0 – 57.7) for those that were HC2 positive and had a viral load of ≤ 181.1 RLU (the median HPV viral load), and 33.8 (95% CI 6.4 – 178.9) for those that were HC2 positive with a HPV viral load > 181.1 RLU.

Conclusion

Women initiating ARVs have a high prevalence of abnormal Pap smears and HR-HPV. Our results underscore the need for locally relevant, rigorous screening protocols for the increasing numbers of women accessing ARV therapy so that the benefits of ARVs are not partially offset by an excess risk in cervical cancer.

Impact and interest:

28 citations in Scopus
24 citations in Web of Science®
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ID Code: 54969
Item Type: Journal Article
Refereed: Yes
Additional Information: Cited By (since 1996): 8
Export Date: 12 November 2012
Source: Scopus
Art. No.: 1471
DOI: 10.1186/1471-2407-9-275
ISSN: 1471-2407
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2009 Moodley et al; licensee BioMed Central Ltd.
Copyright Statement: This is an Open Access article distributed under the terms of
the Creative Commons Attribution License http://creativecommons.org/licenses/by/2.0,
which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited
Deposited On: 20 Nov 2012 02:46
Last Modified: 13 Dec 2016 00:42

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