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.

ABSTRACT

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.