Human papillomavirus prevalence and cytopathology correlation in young Ugandan women using a low-cost liquid-based Pap preparation.
Screening for HPV-driven cervical dysplasia and neoplasia is a significant public health concern in the developing world. The purpose of this study was to use a manual, low-cost liquid-based Pap preparation to determine HPV prevalence in HIV-positive and HIV-negative young women in Kampala, Uganda and to correlate cervical cytopathology with HPV-DNA genotype. About 196 post-partum women aged 18-30 years underwent rapid HIV testing and pelvic examination. Liquid-based cervical cytology samples were processed using a low-cost manual technique. A DNA collection device was used to collect specimens for HPV genotyping. HIV and HPV prevalence was 18 and 64%, respectively. Overall, 49% of women were infected with a high-risk HPV genotype. The most common high-risk HPV genotypes were 16 (8.2%), 33 (7.7%), 35 (6.6%), 45 (5.1%), and 58 (5.1%). The prevalence of HPV 18 was 3.6%. HIV-positive women had an HPV prevalence of 86% compared to 59% in HIV-negative women (P = 0.003). The prevalence of HPV 16/18 did not differ by HIV status. HIV-positive women were infected with a significantly greater number of HPV genotypes compared to HIV-negative women. By multivariate analysis, the main risk factor for HPV infection was coinfection with HIV. HIV-positive women were four times more likely to have abnormal cytology than HIV-negative women (43% vs. 11.6%, P < 0.001). These data highlight that HIV infection is a strong risk factor for HPV infection and resultant abnormal cervical cytology. Notably, the manual low-cost liquid-based Pap preparation is practical in this setting and offers an alternate method for local studies of HPV vaccine efficacy.
Taube
Janis M
JM
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. jtaube1@jhmi.edu
Kamira
Betty
B
Motevalli
Mahnaz
M
Nakabiito
Clemensia
C
Lukande
Robert
R
Kelly
Deidra P
DP
Erozan
Yener S
YS
Gravitt
Patti E
PE
Buresh
Megan E
ME
Mmiro
Francis
F
Bagenda
Danstan
D
Guay
Laura A
LA
Jackson
J Brooks
JB
D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003710:Demography; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D014454:Uganda; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods*; D055815:Young Adult