title: Risk of seropositivity to multiple oncogenic human papillomavirus types among human immunodeficiency virus-positive and -negative Ugandan women.
abstract: To understand the prospects for human papillomavirus (HPV) mass vaccination in the setting of a developing country, we studied the co-occurrence of seropositivity to multiple high-risk (hr) HPV types among HIV-positive and HIV-negative Ugandan women. Our seroepidemiological study was conducted among 2053 women attending antenatal clinics. Sera were analysed for antibodies to eight hrHPV types of the α-7 (18/45) and α-9 (16/31/33/35/52/58) species of HPV by using a multiplex serology assay. Our results show that seropositivity for greater than one hrHPV type was as common (18 %) as for a single type (18 %). HIV-positive women had higher HPV16, HPV18 and HPV45 seroprevalences than HIV-negative women. In multivariate logistic regression analysis, age (>30 years) and level of education (secondary school and above) reduced the risk, whereas parity (>5) and HIV-positivity increased the risk for multiple hrHPV seropositivity. However, in stepwise logistic regression analyses, HIV-status remained the only independent, stand-alone risk factor [odds ratio (OR) 1.7, 95 % confidence interval (CI) 1.0-2.8). On the other hand, the risk of HPV16 or HPV18 seropositive women, as compared to HPV16 or HPV18 seronegative women, for being seropositive to other hrHPV types was not significantly different when they were grouped by HIV-status (ORHPV16/HIV+ 12, 95 % CI 4.5-32 versus ORHPV16/HIV- 22, 95 % CI 15-31 and ORHPV18/HIV+ 58, 95 % CI 14-242 versus ORHPV18/HIV- 45, 95 % CI 31-65). In conclusion, seropositivity to HPV16, HPV18 and to non-vaccine hrHPV types is common in Ugandan women, suggesting that there is little natural cross-protective immunity between the types. HIV-positivity was an independent, stand-alone, albeit moderate risk factor for multiple hrHPV seropositivity. HPV mass vaccination may be the most appropriate method in the fight against cervical cancer in the Ugandan population.
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.|Uganda Virus Research Institute, Entebbe, Uganda.|National Institute for Health and Welfare, Oulu, Finland.
authors.forename: P B
authors.initials: PB
authors.lastname: Namujju
authors.affiliation: German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Waterboer
authors.affiliation: College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: C
authors.initials: C
authors.lastname: Banura
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: R
authors.initials: R
authors.lastname: Muwonge
authors.affiliation: Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: E K
authors.initials: EK
authors.lastname: Mbidde
authors.affiliation: Department of Obstetrics and Gynaecology, San Raphael of St Francis Hospital Nsambya, Kampala, Uganda.
authors.forename: R
authors.initials: R
authors.lastname: Byaruhanga
authors.affiliation: Entebbe Hospital, Entebbe, Uganda.
authors.forename: M
authors.initials: M
authors.lastname: Muwanga
authors.affiliation: National Institute for Health and Welfare, Oulu, Finland.
authors.forename: H-M
authors.initials: HM
authors.lastname: Surcel
authors.affiliation: German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Pawlita
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Lehtinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology*; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D005838:Genotype; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral