title: HIV associated high-risk HPV infection among Nigerian women.
abstract: BACKGROUND
  In developed countries, the incidence of cervical cancer has remained stable in HIV+ women but the prevalence and multiplicity of high-risk HPV (hrHPV) infection, a necessary cause of cervical cancer, appears different comparing HIV+ to HIV- women. Little is known about HIV and HPV co-infection in Africa.
  
  
  METHODS
  We enrolled women presenting at our cervical cancer screening program in Abuja, Nigeria between April and August 2012, and collected information on demographic characteristics, risk factors of HPV infection and samples of exfoliated cervical cells. We used Roche Linear Array HPV Genotyping Test® to characterize prevalent HPV and logistic regression models to estimate the association between HIV and the risk of hrHPV infection.
  
  
  RESULTS
  There were 278 participants, 54% (151) were HIV+, 40% (111) were HIV-, and 6% (16) had unknown HIV status. Of these, data from 149 HIV+ and 108 HIV- women were available for analysis. The mean ages (± SD) were 37.6 (± 7.7) years for HIV+ and 36.6 (± 7.9) years for HIV- women (p-value = 0.34). Among the HIV+ women, HPV35 (8.7%) and HPV56 (7.4%) were the most prevalent hrHPV, while HPV52 and HPV68 (2.8%, each) were the most prevalent hrHPV types among HIV- women. The multivariate prevalence ratio for any hrHPV and multiple hrHPV infections were 4.18 (95% CI 2.05 - 8.49, p-value <0.0001) and 6.6 (95% CI 1.49 - 29.64, p-value 0.01) respectively, comparing HIV + to HIV- women, adjusted for age, and educational level.
  
  
  CONCLUSIONS
  HIV infection was associated with increased risk of any HPV, hrHPV and multiple HPV infections. Oncogenic HPV types 35, 52, 56 and 68 may be more important risk factors for cervical pre-cancer and cancer among women in Africa. Polyvalent hrHPV vaccines meant for African populations should protect against other hrHPV types, in addition to 16 and 18.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. sna094@mail.harvard.edu.
authors.forename: Sally N
authors.initials: SN
authors.lastname: Akarolo-Anthony
authors.forename: Maryam
authors.initials: M
authors.lastname: Al-Mujtaba
authors.forename: Ayotunde O
authors.initials: AO
authors.lastname: Famooto
authors.forename: Eileen O
authors.initials: EO
authors.lastname: Dareng
authors.forename: Olayinka B
authors.initials: OB
authors.lastname: Olaniyan
authors.forename: Richard
authors.initials: R
authors.lastname: Offiong
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
authors.forename: Clement A
authors.initials: CA
authors.lastname: Adebamowo
mesh_terms: D000328:Adult; D060085:Coinfection / Q000821:virology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000821:virology*