title: Epidemiology of HPV Genotypes among HIV Positive Women in Kenya: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  There is a scarcity of data on the distribution of human papillomavirus (HPV) genotypes in the HIV positive population and in invasive cervical cancer (ICC) in Kenya. This may be different from genotypes found in abnormal cytology. Yet, with the advent of preventive HPV vaccines that target HPV 16 and 18, and the nonavalent vaccine targeting 90% of all ICC cases, such HPV genotype distribution data are indispensable for predicting the impact of vaccination and HPV screening on prevention. Even with a successful vaccination program, vaccinated women will still require screening to detect those who will develop ICC from other High risk (HR) HPV genotypes not prevented by current vaccines. The aim of this review is to report on the prevalence of pHR/HR HPV types and multiple pHR/HR HPV genotypes in Kenya among HIV positive women with normal, abnormal cytology and ICC.
  
  
  METHODS
  PUBMED, EMBASE, SCOPUS, and PROQUEST were searched for articles on HPV infection up to August 2nd 2016. Search terms were HIV, HPV, Cervical Cancer, Incidence or Prevalence, and Kenya.
  
  
  RESULTS
  The 13 studies included yielded a total of 2116 HIV-infected women, of which 89 had ICC. The overall prevalence of pHR/HR HPV genotypes among HIV-infected women was 64% (95%CI: 50%-77%). There was a borderline significant difference in the prevalence of pHR/HR HPV genotypes between Female Sex workers (FSW) compared to non-FSW in women with both normal and abnormal cytology. Multiple pHR/HR HPV genotypes were highly prominent in both normal cytology/HSIL and ICC. The most prevalent HR HPV genotypes in women with abnormal cytology were HPV 16 with 26%, (95%CI: 23.0%-30.0%) followed by HPV 35 and 52, with 21% (95%CI: 18%-25%) and 18% (95%CI: 15%-21%), respectively. In women with ICC, the most prevalent HPV genotypes were HPV 16 (37%; 95%CI: 28%-47%) and HPV 18 (24%; 95%CI: 16%-33%).
  
  
  CONCLUSIONS
  HPV 16/18 gains prominence as the severity of cervical disease increases, with HPV 16/18 accounting for 61% (95%CI: 50.0%-70.0%) of all ICC cases. A secondary prevention program will be necessary as this population harbors multiple pHR/HR HPV co-infections, which may not be covered by current vaccines. A triage based on FSW as an indicator may be warranted.
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.|CDC Foundation, Atlanta, GA, United States of America.
authors.forename: Sonia
authors.initials: S
authors.lastname: Menon
authors.affiliation: McGill University, Department of Epidemiology and Biostatistics, Montreal, Canada.
authors.forename: Aibibula
authors.initials: A
authors.lastname: Wusiman
authors.affiliation: Faculty of Medicine, School of Public Health, Imperial College, London, United Kingdom.
authors.forename: Marie Claude
authors.initials: MC
authors.lastname: Boily
authors.affiliation: CDC Foundation, Atlanta, GA, United States of America.
authors.forename: Mbabazi
authors.initials: M
authors.lastname: Kariisa
authors.affiliation: Moi University/Gynocare Fistula Centre, El Doret, Kenya.
authors.forename: Hillary
authors.initials: H
authors.lastname: Mabeya
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.|School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.|Centre for International Health, and Principal for Sexual and Reproductive Health, Burnet Institute, Victoria, Australia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
authors.affiliation: Royal Tropical Institute of the Netherlands/CEBHA, Amsterdam, the Netherlands.|Norwegian Institute of Public Health, Department of International Public Health, Oslo, Norway.
authors.forename: Frode
authors.initials: F
authors.lastname: Forland
authors.affiliation: LSHTM Alumni, Geneva, Switzerland.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Department of Internal Medicine & Infectious Diseases, University Hospital, Ghent, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Callens
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.|AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium.|National Reference Centre for HPV, Brussels, Belgium; Laboratory of Molecular Pathology, AML, Antwerp, Belgium.
authors.forename: Davy
authors.initials: D
authors.lastname: Vanden Broeck
mesh_terms: D016208:Databases, Factual; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis*; D052162:Human papillomavirus 16 / Q000235:genetics; D052161:Human papillomavirus 18 / Q000235:genetics; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D060386:Sex Workers