You are here

  • Home
  • Online First
  • High burden of human papillomavirus and premalignant cervical lesions among women starting HIV treatment in KwaZulu-Natal, South Africa

Article Text

Article menu
Download PDFPDF
Short report
High burden of human papillomavirus and premalignant cervical lesions among women starting HIV treatment in KwaZulu-Natal, South Africa
  1. Nivashnee Naicker1,
  2. Farzana Osman1,
  3. Kunthi Naidoo1,
  4. Nicola Bodley1,
  5. Nokuthandwa Mbambo1,
  6. Sibongile Madlala1,
  7. Thobile Mhlongo1,
  8. Nomfundo Mbatha1,
  9. Andile Maphumulo1,
  10. Pedzisai Munatsi1,
  11. Precious Radebe1,
  12. Lenine Liebenberg1,
  13. Jienchi Dorward1,2,
  14. Paul K Drain3,4,5,
  15. Nigel Garrett1,6
  1. 1University of KwaZulu-Natal, Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
  2. 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
  4. 4Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
  5. 5Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
  6. 6Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
  1. Correspondence to Dr Nivashnee Naicker; Nivashnee.Naicker{at}caprisa.org

Abstract

Objectives Human papillomavirus (HPV) can cause cervical cancer, a leading cause of female cancer mortality in South Africa and worldwide. We assessed the burden of, and factors associated with, HPV infection using a molecular assay and cervical cytology among women living with HIV (WLHIV) in South Africa.

Methods In this cross-sectional analysis, WLHIV initiating antiretroviral therapy (ART) underwent cervical Xpert HPV testing and liquid-based cytology. The Xpert test detects 14 high-risk (hr) HPV types reported in a pooled qualitative result. We evaluated clinical and sociodemographic variables and proportions between women testing positive and negative for hr-HPV, compared cytology with hr-HPV results and assessed associations with HPV positivity.

Results We enrolled 260 WLHIV, median age 31.0 (IQR 26.0–38.0) years. Overall, 91.3% of women were never screened for cervical cancer previously and none received HPV vaccination. In total, 67.3% (175/260) of women tested positive for any hr-HPV type, of which HPV16 and HPV18/45 were detected in 17.3% (45/260) and 22.7% (59/260) of women, respectively, and 56.5% (147/260) tested positive for 11 other hr-types. Of 258 WLHIV, 33.3% (86/258) had abnormal cytology: high-grade squamous intraepithelial lesion (SIL) 7.8% (20/258), low-grade SIL 24.0% (62/258) and atypical squamous cells of undetermined significance 1.6% (4/258). Of these, 93.0% (80/86) tested positive for hr-HPV: 30.0% (24/80) for HPV16, 31.3% (25/80) for HPV18/45 and 92.5% (74/80) for other hr-HPV types. Having a CD4 count<200 cells/µL was associated with hr-HPV infection (adjusted prevalence ratio 2.24; 95% CI 1.69 to 2.99 (p<0.001)).

Conclusions hr-HPV infection and cervical abnormalities are common among WLHIV starting ART, especially those with low CD4 counts, highlighting that early HIV testing and treatment initiation must be prioritised together with cervical cancer screening. The diversity of hr-HPV types suggests a need for vaccines with expanded HPV type coverage in this setting.

  • Human Papillomavirus
  • HIV
  • WOMEN

https://doi.org/10.1136/sextrans-2024-056129

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Handling editor Nadja A Vielot

    • X @Nivi44, @nigegarrett

    • Contributors NN is a subinvestigator on the Simplifying TREAtment and Monitoring for HIV (STREAM HIV) trial and provides clinical oversight of cervical cancer screening, including HPV point-of-care testing. TM is responsible for recruitment of study participants. NMbambo and SM are responsible for all study clinical procedures including cervical sampling for cervical screening. PM and AM are responsible for oversight of data quality control and data entry. KN is responsible for processing and testing of all HPV specimens. LL provided oversight of HPV testing. PR provided access to study data sets. FO performed all statistical analyses. NMbatha assisted with data analysis. JD, PKD and NG designed the STREAM HIV trial and PKD and NG are the trial coprincipal investigators. All authors contributed to data interpretation and approval of the final manuscript. NN serves as guarantor of the study.

    • Funding The Simplifying TREAtment and Monitoring for HIV study is funded by the US National Institutes of Health (R01AI147752). Cepheid provided the Xpert HPV cartridges for this evaluation at no cost. NIH and Cepheid have no role in study design, implementation, data management, analysis, interpretation of outcomes or preparation and dissemination of findings. JD, Academic Clinical Lecturer (CL-2022-13-005), is funded by the UK National Institute of Health and Social Care Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.