Commonness of High Risk Human Papillomavirus among Sexually Active Women: Study Reveals

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Dr Themba Ginindza from the Department of Public Health, at the University of KwaZulu-Natal has led the first study to assess prevalence of and risk factors for high risk-HPV infection in Swaziland, a country severely affected by the HIV epidemic. The study results showed a high prevalence of high risk-HPV infection of about 46.2%, corresponding to 174 046 women (aged between 15 and 49 years old) with high risk-HPV in Swaziland.

‘High risk human papillomavirus infection and the dual burden of HIV remains a huge challenge in some low-income countries such as Swaziland with limited or no data. In this study we estimated the prevalence and investigated determinants of high risk-HPV, including HIV infection among sexually active women in Swaziland,’ revealed Dr Ginindza.

The study titled “Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland’ was conducted on a total of 655 women aged between 15 and 49 years, attending healthcare facilities for routine healthcare-related services in June-July 2015. All women with a history of previous or current sexual activity who provided written informed consent were included. The women were recruited from five healthcare facilities (Mbabane Government, Realign Fitkin Memorial (RFM), Hlatsikhulu, Sithobela and Siteki Public health unit) within the four political regions of Swaziland that had fully functioning CC screening services such as VIA and cryotherapy. Participants were randomly enrolled using a cross-sectional study design and cervical cells were tested for hr-HPV types using GeneXpert HPV Assays.

Standardised questionnaire was administered by a trained nurse, prior to clinical examination and specimen collection, to obtain detailed data on socio-demographic characteristics, sexual, reproductive and gynecological histories. Prior to clinical examination and specimen collection, the nurse midwife inspected perineal, vulvar, vaginal and cervical regions of each woman for evidence of warts, ulcers, discharge, inflammation or tenderness, and recorded all abnormalities according to the study protocol.

Results revealed that among the same population, high prevalence of HIV of 42.7% was found. The age specific prevalence of high risk-HPV significantly decreased with age, yet HIV prevalence increased with age and slightly declined in the 45-49 year age group. The hr-HPV/HIV co-infection was 24.4%, with a high peak in the 30s and decline in older groups. The prevalence of multiple hrHPV infections was statistically significantly higher among HIV-positive women (27.7%) when compared with HIV-negative women.

During sensitivity analysis of the study, HPV16 and HPV31/33/ 35/52/58 types were significantly higher among HIV-positive women when compared to HIV negative women. Multivariate analysis also showed that HIV status was the strongest risk for hrHPV infection. Also the risk of being infected with hr-HPV infection decreased with increasing age and being married.

The key strength of this study was that primary data and new specimens were used to ascertain the study outcomes. Being the first high risk -HPV study done in the country, researchers were able to extrapolate population totals of the 15-49 age group from the 2007–2030 population.

Published on PLOS One journal, this study was led by Ginindza in partnership with collaborating researchers:   Maribel Almonte and Rolando Herrero from the International Agency for Research on Cancer (IARC); Prevention and Implementation Group, France;  Pauline E Jolly from the Department of Epidemiology, University of Alabama at Birmingham, United States of America;  Tsoka-Gwegweni from the  Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal; Elisabete Weiderpas affiliated with the Department of Community Medicine, Faculty of Health Sciences; Department of Research, Cancer Registry of Norway; Institute of Population-Based Cancer Research, Oslo, Norway; Genetic Epidemiology Group, Finland.

In low-income countries, the burden of cervical cancer is a serious health problem, and one which predominantly affects women of reproductive age. Cervical cancer is the fourth most common cancer. Out of the 40 Human Papillomavirus (HPV) genotypes that infect the genital tract, 13 are considered to be “high-risk” and approximately 80% of women worldwide become infected with at least one type before reaching the age of 50 years. High risk HPV is the major and necessary cause of cervical cancer.

The prevalence of HPV infection in women varies greatly in the African continent where some of the highest prevalences are found. Both high risk-HPV and HIV are sexually transmitted infectious agents, and infection by one of the viruses may accelerate transmission of the other. The impact of co-infection of HPV with HIV in the sub-Saharan African countries has created a huge burden of cervical abnormalities since HIV infected women have higher prevalence of high risk HPV. The latter is more likely to be persistent in HIV-infected women, and results in a higher incidence of high grade squamous intraepithelial lesion (HSIL).

Words by: Lihle Sosibo