Prevalence of high-risk HPV types 16 and 18 in relation to immune status and cervical cytological profile of HIV-infected women on antiretroviral therapy in northcentral Nigeria Prévalence des types de VPH 16 et 18 à haut risque en relation avec le statut immunitaire et le profil cytologique cervical des femmes infectées par le VIH sous traitement antirétroviral dans le centre-nord du Nigeria

Abstract

Background: Human papillomavirus (HPV) is a well-established causal agent of cervical cancer, and the first group of viruses to have been acknowledged to prompt carcinogenesis. They are linked with cancers of the uterine cervix, anogenital tumours, and head and neck malignancies. Cervical cancer is by far the most common HPVrelated disease, with about 99% of cervical cancer cases caused by persistent genital high-risk (HR) HPVs, especially types 16 and 18.
Methodology: A hospital-based descriptive analytical study of 300 consenting HIV-infected women on antiretroviral therapy (ART), selected from the three senatorial districts of Plateau State, Nigeria, was conducted over a period of 24 months (November 2018 to November 2020). Blood and cervical specimens were collected from each participant. HIV status was confirmed by standard rapid test on serum sample, CD4⁺ cell count was determined by flow cytometry and HIV viral load estimation was done by GeneXpert nucleic acid amplification technique. Cervical cytology was performed by Papanicolaou (Pap) smear on the cervical specimen and reported according to the 2004 Bethesda system classification. HPV antigen was first detected on the cervical specimen using ELISA, and samples positive for HPV antigen were then subjected to multiplex PCR amplification of E6 and E7 genes to detect HR-HPV (16 and 18) and other HPV types. Standard questionnaires were administered to obtain information on biodata, risk factors and clinical presentations. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0, and significance level was determined at p<0.05.
Results: Of the 300 participants, 84 were positive for HPV of any type, giving an overall prevalence of HPV infection of 28.0%. The prevalence of HPV-16 and HPV-18 types were 5.0% (15/300) and 5.3% (16/300) respectively. Cytological analysis showed that 36.3% (109/300) of the participants had cervical abnormalities ranging from low-grade to high grade squamous intraepithelial lesions and cervical intraepithelial neoplasia. HPV prevalence of 46.8% (51/109) in women with cervical abnormalities was significantly higher than 17.3% (33/191) in women with normal cervical cytology (OR 4.2, p<0.0001). HPV prevalence was higher in women with AG-US (100.0%), ASC-US (78.8%), AC-US (66.7%), ASC-H (33.3%), HSIL (33.3%), HSIL (23.8%), and LSIL (41.2%) compared with women with normal cervical cytology (p<0.001). Aside educational level (p=0.03), none of the analyzed sociodemographic characteristics or risk factors for cervical cancer was significantly associated with HPV infection in the study (p>0.05).
Conclusion: This study showed high prevalence of HPV infections among HIV-infected patients on ART in Plateau State, north-central Nigeria including detection of high-risk HPV types 16 and 18, which are major risk factors for progression of cervical intraepithelial neoplasia to cervical cancer.