Background To assess the prevalence, genotype distribution and risk factors for high-risk HPV among HIV-positive African women, and associations with cervical histological lesions.

Methods The HARP study enrolled HIV-positive women aged 25–50 in Burkina Faso (BF) and South Africa (SA). A stratified sampling strategy was used, with 2/3 of women on ART. Cervical HPV genotyping was performed using InnoLipa. Four-quadrant cervical biopsies were obtained among women with abnormalities detected by at least one test or by colposcopy.

Results 628 and 624 women were enrolled in BF and SA, respectively. The distribution of CD4+ count (cells/µL) was similar in both sites: 68% with CD4+ ≥ 350 and 10% with CD4+ < 200. Prevalence of HR-HPV genotypes was 62% among women in BF and 78% in SA, and, overall, 67%, 73% and 84% among women with CD4+ ≥ 350, 200–349 and < 200, respectively (Table). The 4 most common genotypes in BF were HPV52 (20%), HPV51 (12%), HPV35 (9%), HPV66 (8%); and in SA, HPV52 (24%), HPV16 (15%), HPV51 (14%) and HPV35 (14%). Multiple types were observed in 41% and 55% of HR-HPV-positive women in BF and SA, respectively; and increased with decreasing CD4 count (46%, 52% and 63%, respectively, P-trend = 0.004). HPV types 58, 33 and 16 were most strongly associated with CIN2+ (OR = 5.06, OR = 4.62, OR = 4.02) and types 16, 35 and 58 were most strongly associated with CIN3+ (OR = 4.59, OR = 3.36, OR = 2.96). Decreasing CD4+ count and younger age were associated with higher HR-HPV prevalence in both countries (Table). Multiple sex partners, smoking and lower income were also significantly associated with HR-HPV in SA.

Conclusions HR-HPV prevalence is high among HIV-positive women with genotype distribution similar in both countries. HR-HPV prevalence is associated with young age and lower CD4+ count. Whilst HPV52 is the most prevalent type, HPV16 is most strongly associated with increasing lesion severity.