Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa

Admire Chikandiwa (1) , Helen Kelly (2) , Bernard Sawadogo (3) , Jean Ngou (4) , Pedro T Pisa (1) , Lorna Gibson (2) , Marie-Noelle Didelot (4) , Nicolas Meda (5) , Helen A Weiss (2) , Michel Segondy (4) , Philippe Mayaud (2) , Sinead Delany-Moretlwe (1)

1 WITS - University of the Witwatersrand [Johannesburg]
2 LSHTM - London School of Hygiene and Tropical Medicine
3 CRIS - Centre de Recherche Internationale pour la Sante
4 Pathogénèse et contrôle des infections chroniques (PCCI)
5 UJZK - Université Joseph Ki-Zerbo [Université de Ouagadougou, Burkina Faso]

Objective: To report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV) and anogenital warts (AGW) among women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA), and to explore HIV-related factors associated with these outcomes. Methods: We enrolled 1238 WLHIV (BF = 615; SA = 623) aged 25–50 years and followed them at three time points (6, 12 and 16 months) after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW. Results:Women in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p<0.001) and incident LR-HPV infection (BF: 25.8% vs. SA: 31.6%, p = 0.05). Prevalence of persistent LR-HPV was similar in the two countries (BF: 33.3% vs. SA: 30.4%; p = 0.54), as were prevalence and incidence of AGW (Prevalence: BF: 7.5% vs. SA: 5.7%; p = 0.21; Incidence: BF: 2.47 vs. SA: 2.33 per 100 person-years; p = 0.41). HPV6 was associated with incident AGW (BF: adjusted Hazard Ratio (aHR) = 4.88; 95%CI: 1.36–17.45; SA: aHR = 5.02; 95%CI: 1.40–17.99). Prevalent LR-HPV (BF: adjusted Odds Ratio [aOR = 1.86]; 95%CI: 1.01–3.41; SA: aOR = 1.75; 95%CI: 0.88–3.48); persistent LR-HPV (BF: aOR = 1.92; 95%CI: 0.44–8.44; SA: aOR = 2.81; 95%CI: 1.07–7.41) and prevalent AGW (BF: aOR = 1.53; 95%CI: 0.61–3.87; SA: aOR = 4.11; 95%CI: 1.20–14.10) were each associated with low CD4+ counts (i.e. <200 vs. >500 cells/μL). Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes. Conclusion: LR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population.

Domaines: Santé publique et épidémiologie; Maladies infectieuses

Admire Chikandiwa, Helen Kelly, Bernard Sawadogo, Jean Ngou, Pedro T Pisa, et al.. Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa. PLoS ONE, 2018, 13 (5), pp.e0196018. ⟨10.1371/journal.pone.0196018⟩. ⟨hal-01890051⟩