Epidemiology of cervical human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among a cohort of HIV-infected and uninfected Ghanaian women

BMC Cancer. 2017 Oct 16;17(1):688. doi: 10.1186/s12885-017-3682-x.

Abstract

Background: There is limited data in Ghana on the epidemiology of HPV and cervical neoplasia and their associations with HIV. This study aimed to compare among HIV-1 seropositive and HIV-seronegative Ghanaian women: (1) the prevalence, genotype distribution and risk factors associated with cervical HPV infection; and (2) the prevalence and risk factors associated with abnormal cervical cytology.

Methods: A comparative frequency-matched study was conducted in a systematic sample of women aged ≥18 years attending HIV and general outpatient clinics in Cape Coast Teaching Hospital, Ghana. Participants were interviewed and cervical samples collected for HPV genotyping (Seegene Anyplex-II HPV28) and cytological testing.

Results: Overall, 333 women were recruited, 163 HIV-1 seropositive and 170 HIV-seronegative women of mean age 43.8 years (SD ±9.4)) and 44.3 years (SD ±12.8), respectively. The prevalence of 14 high-risk (hr) HPV genotypes was higher among HIV-1 seropositive women (65.6% vs. 30.2%, P < 0.0001), as was proportion with multiple hr.-HPV infections (60.6% vs. 21.3%, P < 0.0001). HPV35 was the most prevalent hr.-HPV genotype in both groups (11.9% and 5.3%). The main factors associated with hr.-HPV infection were age for HIV-positive women and circumcision status of main sexual partner for both HIV-negative and positive women. Abnormal cervical cytology prevalence was higher among HIV-1 seropositive women (any SIL: 14.1% vs. 1.2%, P < 0.0001; low-grade SIL [LSIL]: 4.9% vs. 0.6%, P = 0.02; high-grade SIL: 1.8% vs. 0%, P = 0.07). Among HIV-1 seropositive women, number of pregnancies and CD4+ cell count were associated with LSIL+ cytology. There was strong association between LSIL+ abnormalities and HPV35 (aOR = 4.7, 95%CI: 1.3-17.7, P = 0.02).

Conclusions: HIV-1 infected women bear significant burden of HPV infection and related disease. Prevention and screening programmes should be specifically deployed for this population in Ghana.

Keywords: Cervical cancer; Genotyping; Ghana; Human immunodeficiency virus (HIV); Human papillomavirus (HPV); Squamous intraepithelial lesions (SIL).

MeSH terms

  • Adult
  • Female
  • Genotype
  • Ghana / epidemiology
  • HIV / pathogenicity
  • HIV Infections / epidemiology*
  • HIV Infections / pathology
  • HIV Infections / virology
  • Humans
  • Middle Aged
  • Papillomaviridae / pathogenicity
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Squamous Intraepithelial Lesions of the Cervix / complications
  • Squamous Intraepithelial Lesions of the Cervix / epidemiology*
  • Squamous Intraepithelial Lesions of the Cervix / pathology
  • Squamous Intraepithelial Lesions of the Cervix / virology