Abstract

KANGETHE, James M. et al. Confronting the human papillomavirus-HIV intersection: Cervical cytology implications for Kenyan women living with HIV. South. Afr. j. HIV med. (Online) [online]. 2023, vol.24, n.1, pp.1-12. ISSN 2078-6751.  http://dx.doi.org/10.4102/sajhivmed.v24i1.1508.

BACKGROUND: 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: We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV. METHOD: We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya's national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert^® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations. RESULTS: 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]: 2.7-14.1, P = 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: 1.3-4.1, P = 0.005. CONCLUSION: Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.

Keywords : high-risk human papillomavirus; cervical cytology; cervical cancer; women living with HIV; antiretroviral therapy; Kenya.

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