Prevalence and risk factors for High-Risk Human Papillomavirus (hrHPV) infection among HIV-infected and Uninfected Rwandan women: implications for hrHPV-based screening in Rwanda.
BACKGROUND
New World Health Organization guidelines recommend high-risk human papillomavirus (hrHPV) screen-and-treat strategies for cervical cancer prevention. We describe risk of, and risk factors for, testing hrHPV positive in a pilot study of hrHPV screen-and-treat conducted in Rwanda.


METHODS
A total of 2,964 women, 1,289 HIV-infected (HIV [+]) and 1,675 HIV-uninfected (HIV [-]), aged 30-60 years and living in Rwanda were enrolled in 2010. Cervical specimens were collected and tested by careHPV, a DNA test for a pool of 14 hrHPV types. Prevalence with binomial 95% confidence intervals (95% CI) and determinants of testing hrHPV positive were calculated.


RESULTS
hrHPV prevalence was higher in HIV [+] (31.8%, 95% CI = 29.2-34.4%) than HIV [-] women (8.2%, 95% CI = 6.7-9.8%; P < 0.0001). Among HIV [+] women, there was a significant trend (ptrend <0.001) of higher hrHPV prevalence with lower CD4 cell count, with the highest hrHPV prevalence among those with <200 CD4 cell counts (45.5%, 95% CI = 34.8-56.4%). In multivariate analysis of HIV [+] women, testing hrHPV positive was positively associated CD4 count of <200 cells/μL, history of 3 or more sexual partners, and history of using hormonal contraception, and negatively associated with older age. In HIV [-] women, testing hrHPV positive was negatively associated only with older age groups of 45-49 and 50-60 years and surprisingly was not associated with lifetime number of sexual partners.


CONCLUSIONS
hrHPV prevalence is high in HIV [+], especially in women with the lowest CD4 cell counts, which may have implications for utilizing hrHPV-based screening strategies such as screen-and-treat in these high-risk subgroups.
Regional Alliance for Sustainable Development (RASD), P. O. Box 1544, Kigali, Rwanda.
Jean d'Amour
Jd
Sinayobye
Albert Einstein College of Medicine, Bronx, NY USA.
Marc
M
Sklar
Albert Einstein College of Medicine, Bronx, NY USA ; Rutgers University, New Brunswick, NJ USA.
Donald R
DR
Hoover
NY Medical College, Valhalla, NY USA.
Qiuhu
Q
Shi
Regional Alliance for Sustainable Development (RASD), P. O. Box 1544, Kigali, Rwanda.
Jean Claude
JC
Dusingize
John Stroger (Cook County) Hospital, Chicago, IL USA.
Mardge
M
Cohen
Regional Alliance for Sustainable Development (RASD), P. O. Box 1544, Kigali, Rwanda.
Eugene
E
Mutimura
University of Rwanda, College of Medicine and Health Sciences, Butare, Rwanda.
Brenda
B
Asiimwe-Kateera
Albert Einstein College of Medicine, Bronx, NY USA ; Global Coalition Against Cervical Cancer, Arlington, VA USA.
Philip E
PE
Castle
Regional Alliance for Sustainable Development (RASD), P. O. Box 1544, Kigali, Rwanda.
Howard
H
Strickler
Albert Einstein College of Medicine, Bronx, NY USA.
Kathryn
K
Anastos
Cervical cancer; HIV; HPV; Screening