Confronting the human papillomavirus鈥揌IV intersection: Cervical cytology implications for Kenyan women living with HIV

Wednesday, November 1, 2023

By James M. Kangethe, Stephen Gichuhi, Eddy Odari, Jillian Pintye, Kenneth Mutai, Leila Abdullahi, Alex Maiyo, Marianne W. Mureithi

Abstract

Background:听High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV.

Objectives:听We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV.

Method:听We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya鈥檚 national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert庐听assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations.

Results:听We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7鈥�14.1,听P听= 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3鈥�4.1,听P听= 0.005).

Conclusion:听Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.