title: Variability of high risk HPV genotypes among HIV infected women in Mwanza, Tanzania- the need for evaluation of current vaccine effectiveness in developing countries.
abstract: BACKGROUND
  High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania.
  
  
  METHODS
  A cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11.
  
  
  RESULTS
  A total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005).
  
  
  CONCLUSIONS
  Significant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, P.O.Box 1464, Mwanza, Tanzania.
authors.forename: Fridolin
authors.initials: F
authors.lastname: Mujuni
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O.Box 1464, Mwanza, Tanzania.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: Mirambo
authors.affiliation: Department of Pathology, Weill Bugando School of Medicine, P.O.Box 1464, Mwanza, Tanzania.
authors.forename: Peter
authors.initials: P
authors.lastname: Rambau
authors.affiliation: Institute of Clinical and Molecular Virology, Enlargen University, Schlossgarten 4, 91054 Erlangen, Germany.
authors.forename: Korn
authors.initials: K
authors.lastname: Klaus
authors.affiliation: Medical Mission Institute, Salvatorstrasse 7, 97067 Wuerzburg, Germany.
authors.forename: Muller
authors.initials: M
authors.lastname: Andreas
authors.affiliation: Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, P.O.Box 1464, Mwanza, Tanzania.
authors.forename: Dismas
authors.initials: D
authors.lastname: Matovelo
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
authors.forename: Mtebe
authors.initials: M
authors.lastname: Majigo
authors.affiliation: Medical Mission Institute, Salvatorstrasse 7, 97067 Wuerzburg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Kasang
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O.Box 1464, Mwanza, Tanzania.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
keywords: HIV; HPV; High risk genotypes; Mwanza