title: Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya.
abstract: BACKGROUND
  We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women.
  
  
  METHODS
  Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy.
  
  
  RESULTS
  In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (P<0.001) and CIN2/3 among non-users of cART (P=0.013). Combination antiretroviral therapies users (≥2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users=0.77, 95% confidence interval (CI): 0.61-0.96) and multiple infections (PR=0.68, 95% CI: 0.53-0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age <35 years to 53.3% in ≥45 years.
  
  
  CONCLUSIONS
  The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies ( ≥2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3.
authors.affiliation: International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, Lyon, France. devuysth@iarc.fr
authors.forename: H
authors.initials: H
authors.lastname: De Vuyst
authors.forename: N R
authors.initials: NR
authors.lastname: Mugo
authors.forename: M H
authors.initials: MH
authors.lastname: Chung
authors.forename: K P
authors.initials: KP
authors.lastname: McKenzie
authors.forename: E
authors.initials: E
authors.lastname: Nyongesa-Malava
authors.forename: V
authors.initials: V
authors.lastname: Tenet
authors.forename: J W
authors.initials: JW
authors.lastname: Njoroge
authors.forename: S R
authors.initials: SR
authors.lastname: Sakr
authors.forename: Cjl M
authors.initials: CM
authors.lastname: Meijer
authors.forename: P J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: F S
authors.initials: FS
authors.lastname: Rana
authors.forename: S
authors.initials: S
authors.lastname: Franceschi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000821:virology