Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya

BACKGROUND: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. METHODS: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. RESULTS: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (P < 0.001) and CIN2/3 among non-users of cART (P = 0.013). Combination antiretroviral therapies users (>= 2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users = 0.77, 95% confidence interval (CI): 0.61-0.96) and multiple infections (PR = 0.68, 95% CI: 0.53-0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age <35 years to 53.3% in >= 45 years. CONCLUSION: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies (>= 2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3. British Journal of Cancer (2012) 107, 1624-1630. doi:10.1038/bjc.2012.441 www.bjcancer.com Published online 2 October 2012 (c) 2012 Cancer Research UK