title: Epidemiology of high-risk human papillomavirus and cervical lesions in African women living with HIV/AIDS: effect of anti-retroviral therapy.
abstract: To describe the effect of antiretroviral therapy (ART) and HIV-related factors on high-risk human papillomavirus (HR-HPV) and high-grade cervical intraepithelial neoplasia lesions (CIN2+) among women living with HIV/AIDS (WLHA) in sub-Saharan Africa.
  
  
  
  Prospective cohort of WLHA in Ouagadougou, Burkina Faso (BF) and Johannesburg, South Africa (SA). Recruitment was stratified by ART status.
  
  
  
  At baseline and endline (median 16 months), cervical samples, and biopsies were analyzed for HPV genotyping (InnoLiPA) and by histology. Logistic regression was used to estimate associations of ART and HIV-related factors with HR-HPV and CIN2+ outcomes, and all results presented are adjusted for baseline CD4 cell count.
  
  
  
  Among 1238 enrolled WLHA (BF = 615; SA = 623), HR-HPV prevalence was 59.1% in BF and 79.1% in SA. CIN2+ prevalence was 5.8% in BF and 22.5% in SA. Compared with long-duration ART users (>2 years), HR-HPV prevalence was higher among short-duration ART users [≤2 years; adjusted prevalence ratio (aPR) = 1.24, 95% confidence interval (CI) 1.04-1.47] in BF, and CIN2+ prevalence was higher among short-duration ART users [adjusted odds ratio (aOR) = 1.99, 95% CI 1.12-3.54) and ART-naive participants (aOR = 1.87, 95% CI 1.11-3.17) in SA. Among 963 (77.8%) women seen at endline, HR-HPV persistence was 41.1% in BF and 30.2% in SA; CIN2+ incidence over 16-months was 1.2% in BF and 5.8% in SA. HR-HPV persistence was associated with being ART-naive in BF (aPR = 1.89, 95% CI 1.26-2.83), and with short-duration ART use (aPR = 1.78, 95% CI 1.11-2.86) and HIV-1 plasma viral load at least 1000 copies/ml (aPR = 2.87, 95% CI 1.63-5.05) in SA. CIN2+ incidence was reduced among women on ART in SA (aOR = 0.39, 95% CI 0.15-1.01).
  
  
  
  Prolonged and effective ART is important in controlling HR-HPV and the development of CIN2+.
authors.affiliation: aLondon School of Hygiene and Tropical Medicine, London, UK bCentre de Recherche Internationale en Santé, University of Ouagadougou, Burkina Faso cRHI, University of the Witwatersrand, Johannesburg, South Africa dINSERM U1058 and University Hospital (CHRU), Montpellier, France eNational Health Laboratory Services, Johannesburg, South Africa fMRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Kelly
authors.forename: Bernard
authors.initials: B
authors.lastname: Sawadogo
authors.forename: Admire
authors.initials: A
authors.lastname: Chikandiwa
authors.forename: Michel
authors.initials: M
authors.lastname: Segondy
authors.forename: Clare
authors.initials: C
authors.lastname: Gilham
authors.forename: Olga
authors.initials: O
authors.lastname: Lompo
authors.forename: Tanvier
authors.initials: T
authors.lastname: Omar
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Didelot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D013019:South Africa / Q000453:epidemiology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
chemical_list: D044966:Anti-Retroviral Agents