title: Risk factors associated with human papillomavirus prevalence and cervical neoplasia among Cameroonian women.
abstract: BACKGROUND
  This study used community-based cervical cancer screening for high-risk human-papillomavirus (HPV) to determine demographic and lifestyle factors associated with HPV prevalence and cervical intraepithelial neoplasia grade 2 or worse (CIN2+).
  
  
  METHODS
  Women (n=838) aged 25-65 years were recruited in two sequential studies in Cameroon. Demographic and historical data were obtained from participants and specimens were self-collected for HPV-testing using real-time PCR. HPV-positive women underwent biopsy and endocervical curettage. Associations were determined using bivariate analysis and logistic regression.
  
  
  RESULTS
  HPV and self-reported HIV prevalence were 39.0% and 9.2%, respectively. Eighteen (9.3%) CIN2+ lesions were found among HPV-positive women. Housewives had a higher risk of being HPV infected (OR=1.60, p=0.010). HIV co-infection (aOR=3.44, p<0.001) and hormonal contraception (aOR=1.97, p=0.007) were associated with increased HPV prevalence. HPV-positive women who used condoms during sexual intercourse were at lower risk of CIN2+ (aOR=0.15, p=0.029). CIN2-3 lesions were found in women younger than 50 years, with a median age of 36 years (31-44). HPV-16/18-positive women had a 4.65-fold increased risk of CIN2+ (p=0.015).
  
  
  CONCLUSIONS
  Young, single women and housewives were at higher risk of HPV infection. Preventive strategies for cervical cancer in low-resource settings should target women aged 30-50 years for HPV screening, and should focus treatment and follow-up on HPV-16/18-positive women. Further studies are needed to clarify if other risk factors require attention.
authors.affiliation: Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1205 Geneva, Switzerland. Electronic address: rosapintocatarino@gmail.com.
authors.forename: Rosa
authors.initials: R
authors.lastname: Catarino
authors.affiliation: Geneva Foundation for Medical Education and Research, 1211 Geneva, Switzerland. Electronic address: pierrevassilakos@bluewin.ch.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vassilakos
authors.affiliation: Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon. Electronic address: pmtebeu@yahoo.fr.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Tebeu
authors.affiliation: Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1205 Geneva, Switzerland. Electronic address: sonja.schafer@hcuge.ch.
authors.forename: Sonja
authors.initials: S
authors.lastname: Schäfer
authors.affiliation: Department of Gynecology and Obstetrics, Edea Regional Hospital, Edea, Cameroon. Electronic address: bongoecam@yahoo.com.
authors.forename: Adamo
authors.initials: A
authors.lastname: Bongoe
authors.affiliation: Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1205 Geneva, Switzerland. Electronic address: patrick.petignat@hcuge.ch.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
mesh_terms: D000328:Adult; D000368:Aged; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D052162:Human papillomavirus 16; D052161:Human papillomavirus 18; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology*
keywords: Cameroon; Cervical cancer; Human papillomavirus; Risk factors