Epidemiology of HPV Genotypes among HIV Positive Women in Kenya: A Systematic Review and Meta-Analysis

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Abstract

Background

There is a scarcity of data on the distribution of human papillomavirus (HPV) genotypes in the HIV positive population and in invasive cervical cancer (ICC) in Kenya. This may be different from genotypes found in abnormal cytology. Yet, with the advent of preventive HPV vaccines that target HPV 16 and 18, and the nonavalent vaccine targeting 90% of all ICC cases, such HPV genotype distribution data are indispensable for predicting the impact of vaccination and HPV screening on prevention. Even with a successful vaccination program, vaccinated women will still require screening to detect those who will develop ICC from other High risk (HR) HPV genotypes not prevented by current vaccines. The aim of this review is to report on the prevalence of pHR/HR HPV types and multiple pHR/HR HPV genotypes in Kenya among HIV positive women with normal, abnormal cytology and ICC.

Methods

PUBMED, EMBASE, SCOPUS, and PROQUEST were searched for articles on HPV infection up to August 2nd 2016. Search terms were HIV, HPV, Cervical Cancer, Incidence or Prevalence, and Kenya.

Results

The 13 studies included yielded a total of 2116 HIV-infected women, of which 89 had ICC. The overall prevalence of pHR/HR HPV genotypes among HIV-infected women was 64% (95% CI: 50%-77%). There was a borderline significant difference in the prevalence of pHR/HR HPV genotypes between Female Sex workers (FSW) compared to non-FSW in women with both normal and abnormal cytology. Multiple pHR/HR HPV genotypes were highly prominent in both normal cytology/HSIL and ICC. The most prevalent HR HPV genotypes in women with abnormal cytology were HPV 16 with 26%, (95% CI: 23.0%-30.0%) followed by HPV 35 and 52, with 21% (95% CI: 18%-25%) and 18% (95% CI: 15%-21%), respectively. In women with ICC, the most prevalent HPV genotypes were HPV 16 (37%; 95% CI: 28%-47%) and HPV 18 (24%; 95% CI: 16%-33%).

Conclusion

HPV 16/18 gains prominence as the severity of cervical disease increases, with HPV 16/18 accounting for 61% (95% CI: 50.0%-70.0%) of all ICC cases. A secondary prevention program will be necessary as this population harbors multiple pHR/HR HPV co-infections, which may not be covered by current vaccines. A triage based on FSW as an indicator may be warranted.

 

Authors & affiliation: 
By:Menon, S (Menon, Sonia)[ 1,4 ] ; Wusiman, A (Wusiman, Aibibula)[ 2 ] ; Boily, MC (Boily, Marie Claude)[ 3 ] ; Kariisa, M (Kariisa, Mbabazi)[ 4 ] ; Mabeya, H (Mabeya, Hillary)[ 5 ] ; Luchters, S (Luchters, Stanley)[ 1,6,7 ] ; Forland, F (Forland, Frode)[ 8,9 ] ; Rossi, R (Rossi, Rodolfo)[ 10 ] ; Callens, S (Callens, Steven)[ 11 ] ; Broeck, DV (vanden Broeck, Davy)[ 1,12,13,14 ] [ 1 ] Univ Ghent, ICRH, Ghent, Belgium Show more [ 2 ] McGill Univ, Dept Epidemiol & Biostat, Montreal, PQ, Canada Show more [ 3 ] Imperial Coll, Sch Publ Hlth, Fac Med, London, England [ 4 ] CDC Fdn, Atlanta, GA 30303 USA Show more [ 5 ] Moi Univ, Gynocare Fistula Ctr, El Doret, Kenya Show more [ 6 ] Monash Univ, Sch Publ Hlth & Prevent Med, Clayton, Vic 3800, Australia Show more [ 7 ] Burnet Inst, Ctr Int Hlth & Principal Sexual & Reprod Hlth, Melbourne, Vic, Australia [ 8 ] Royal Trop Inst Netherlands, CEBHA, Amsterdam, Netherlands Show more [ 9 ] Norwegian Inst Publ Hlth, Dept Int Publ Hlth, Oslo, Norway [ 10 ] LSHTM Alumni, Geneva, Switzerland Show more [ 11 ] Univ Hosp, Dept Internal Med & Infect Dis, Ghent, Belgium Show more [ 12 ] Univ Antwerp, Lab Cell Biol & Histol, AMBIOR, Antwerp, Belgium [ 13 ] Natl Reference Ctr HPV, Brussels, Belgium [ 14 ] AML, Lab Mol Pathol, Antwerp, Belgium
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Published In: 
PLOS ONE 11(10)
Publication date: 
Thursday, October 20, 2016
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