title: Prevalence and determinants of high-risk human papillomavirus infection in women from a sub-Saharan African community.
abstract: BACKGROUND
  Human papillomavirus infection with high-risk types (HR-HPV) is a necessary cause of cervical cancer, the most common malignancy among sub-Saharan African women. Little is known about prevalence of cervical HR-HPV infection in this region.
  
  
  METHODS
  A cross-sectional study of 1528 women examined the determinants of HR-HPV infection among women in Kinshasa, Democratic Republic of Congo. Information was collected on sociodemographic, reproductive, lifestyle characteristics, and health-seeking behaviors. Cervical samples were tested for HPV-DNA by Hybrid Capture 2. Unconditional logistic regression identified predictors of HPV positivity.
  
  
  RESULTS
  HR-HPV prevalence was 12.5% in all women and 8.7% in women with normal cytology. Prevalence was highest (18.3%) in individuals <35 years of age and gradually decreased with age. Excess HR-HPV infection risk was observed in women who were smokers (odds ratio [OR] = 1.60; 95% confidence interval [CI]: 1.11-2.31), divorced/separated (OR = 1.60; 95% CI: 1.11-2.32), in polygamous marriages (OR = 1.28; 95% CI: 0.90-1.82), using medical contraceptives (OR = 2.40; 95% CI: 1.20-4.80), and who preferred male physicians (OR = 1.90; 95% CI: 1.20-3.05). A statistically marginal increase was found in women whose partners had sex with prostitutes (OR = 2.40; 95% CI: 0.72-8.01). A higher standard of living was associated with reduced risk.
  
  
  CONCLUSIONS
  HR-HPV positivity was associated with behavioral and sexual characteristics thought to affect risk of new infections and immune function. However, HPV prevalence did not correlate with numbers of sex partners, possibly because of a high HPV infection rate per sexual contact or because subjects were older than 30 years. Our study should assist in designing strategies for control of cervical cancer in this low-resource, high cervical cancer risk setting in sub-Saharan Africa.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Sangwa-Lugoma
authors.forename: Agnihotram V
authors.initials: AV
authors.lastname: Ramanakumar
authors.forename: Salaheddin
authors.initials: S
authors.lastname: Mahmud
authors.forename: Jean
authors.initials: J
authors.lastname: Liaras
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Kayembe
authors.forename: Rahma R
authors.initials: RR
authors.lastname: Tozin
authors.forename: Attila
authors.initials: A
authors.lastname: Lorincz
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000302:isolation & purification; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D016387:Women's Health
chemical_list: D004279:DNA, Viral