Epidemiology of Human Papillomavirus genotypes and prevalence of cervical precancerous lesions among women living with HIV: results from a pilot cervical cancer screening program in Uganda

BACKGROUND: There is lack of data on distribution of human papillomavirus (HPV) genotypes among women living with HIV (WLHIV) in Uganda. Yet, WLHIV are more likely to be infected with human papillomavirus (HPV) and to have persistent HPV progressing to cervical pre-cancer and/or invasive cervical cancer compared to HIV negative women. Information on epidemiology of high-risk HPV (hrHPV) infections and prevalence of specific HPV genotypes is very vital in mounting an effective response to the growing challenge of cervical cancer in Uganda.
METHODS: A pilot cervical cancer screening program was conducted between September and April 2021. HPV testing using self-collected vaginal samples was offered to WLHIV aged 25-49 attending antiretroviral clinics in 10 high-volume hospitals. Samples were processed using GeneXpert and Hologic Panther devices. HPV+ women were referred for Visual Inspection with Acetic acid (VIA) triage, and those having precancerous or cancerous lesions were treated with cryotherapy, thermocoagulation, LEEP or referred for further management. Data was collected from hospital registers to determine the distribution of HPV genotypes and prevalence of cervical precancerous lesions among HPV positive WLHIV.
RESULTS: Across the 10 pilot sites, 6,611 WLHIV were offered screening and 6,012 (91%) had a valid result. HPV positivity rate was 30% (1,817). Of the HPV+ women, 214 (12%) were HPV16 positive, 187 (20%) were HPV 18/45 and 1,203 (66%) had other hrHPV genotypes as a pooled result including HPV 31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68. 213 (12%) of the women had multiple infections with hrHPV genotypes.
823 (45%) of the HPV+ women were effectively linked to care and triaged with VIA and 173 (21%) were found with precancerous lesions, of whom 137 (79%) were treated as appropriate. Fourteen women were found to be suspicious of cancer and referred for further management.
CONCLUSIONS: HrHPV infections are common among WLHIV, including HPV16 and HPV18 that cause majority of cervical cancer. A significant proportion of women have infections that progress to cervical pre-cancer. HPV+ WLHIV found to have no lesions need to be proactively followed-up to ensure that non-regressive infections are appropriately managed. Cervical cancer efforts need to intensify screening among WLHIV.

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