Genital warts and infection with human immunodeficiency virus in high-risk women in Burkina Faso: a longitudinal study.
BACKGROUND
Human papillomaviruses are the most common sexually transmitted infections, and genital warts, caused by HPV-6 and 11, entail considerable morbidity and cost. The natural history of genital warts in relation to HIV-1 infection has not been described in African women. We examined risk factors for genital warts in a cohort of high-risk women in Burkina Faso, in order to further describe their epidemiology.


METHODS
A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso. Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections. In a subset of 306 women, cervical HPV DNA was tested at enrollment.


RESULTS
Genital wart prevalence at baseline was 1.6% (8/492) among HIV-uninfected and 7.0% (19/273) among HIV-1 seropositive women. Forty women (5.2%) experienced at least one incident GW episode. Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤ 200 cells/μL. Incident genital warts were also associated with concurrent bacterial vaginosis, and genital ulceration. Antiretroviral therapy was not protective against incident or persistent genital warts. Detection of HPV-6 DNA and abnormal cervical cytology were strongly associated with incident genital warts.


CONCLUSIONS
Genital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population.
London School of Hygiene & Tropical Medicine, London, UK. andrea.low@lshtm.ac.uk
Andrea J
AJ
Low
Tim
T
Clayton
Issouf
I
Konate
Nicolas
N
Nagot
Abdoulaye
A
Ouedraogo
Charlotte
C
Huet
Marie-Noelle
MN
Didelot-Rousseau
Michel
M
Segondy
Philippe
P
Van de Perre
Philippe
P
Mayaud
D000293:Adolescent; D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D003218:Condylomata Acuminata / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D005260:Female; D006678:HIV / Q000302:isolation & purification / Q000502:physiology*; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D052163:Human papillomavirus 6 / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
Br J Cancer. 2005 Oct 31;93(9):1068-76
16106268
J Natl Cancer Inst. 2009 Aug 19;101(16):1120-30
19648510
J Virol. 1997 Sep;71(9):6427-32
9261360
N Engl J Med. 1998 Feb 12;338(7):423-8
9459645
J Infect Dis. 2004 Jul 1;190(1):37-45
15195241
Sex Transm Infect. 2001 Aug;77(4):248-54
11463923
Obstet Gynecol. 2000 Sep;96(3):403-9
10960634
Clin Microbiol Rev. 1989 Apr;2(2):166-90
2539898
J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):380-8
17468666
J Virol Methods. 2006 Aug;135(2):181-5
16675035
AIDS. 2008 Jun 19;22(10):1213-9
18525267
J Acquir Immune Defic Syndr. 2005 Aug 1;39(4):454-8
16010169
J Infect Dis. 2005 Apr 1;191(7):1129-39
15747249
J Infect Dis. 2010 Mar;201(5):681-90
20105077
J Infect Dis. 2005 Dec 15;192(12):2099-107
16288373
Sex Transm Dis. 2002 Aug;29(8):427-35
12172526
Am J Obstet Gynecol. 2004 May;190(5):1241-8
15167825
Br J Cancer. 2006 Aug 7;95(3):355-62
16832413
Vaccine. 2006 Aug 31;24 Suppl 3:S3/52-61
16950018
J Clin Microbiol. 1991 Feb;29(2):297-301
1706728
J Clin Virol. 2005 Mar;32 Suppl 1:S82-90
15753016
J Clin Microbiol. 2003 Sep;41(9):4451-3
12958291
J Infect Dis. 2009 Mar 15;199(6):805-14
19199546
Clin Infect Dis. 2008 Sep 1;47(5):610-5
18637758
Cytopathology. 2002 Feb;13(1):4-10
11985563
Cancer Epidemiol Biomarkers Prev. 2010 Jan;19(1):159-69
20056635
Virology. 2006 Dec 5-20;356(1-2):23-34
16949120
Sex Transm Infect. 2010 Oct;86(5):342-4
20410079