1
|
Chachage M, Parikh AP, Mahenge A, Bahemana E, Mnkai J, Mbuya W, Mcharo R, Maganga L, Mwamwaja J, Gervas R, Kibuuka H, Maswai J, Singoei V, Iroezindu M, Fasina A, Esber A, Dear N, Imbach M, Crowell TA, Hern J, Song X, Hoelscher M, Polyak CS, Ake JA, Geldmacher C. High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa. AIDS 2023; 37:625-635. [PMID: 36398743 PMCID: PMC9994804 DOI: 10.1097/qad.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical cancer is a common preventable cancer among African women living with HIV (WLWH). Molecular diagnostics for high-risk human papillomavirus (HR-HPV) genotypes are standard components of cervical cancer screening in resource-rich countries but not in resource-limited settings. We evaluated HR-HPV genotypes among women with and without HIV in four African countries to inform cervical cancer preventive strategies. METHODS The African Cohort Study (AFRICOS) enrolled participants with and without HIV at 12 clinics in Tanzania, Kenya, Uganda, and Nigeria. Cervical cytobrush specimens from women were genotyped for 14 HR-HPV types using the multiplex Seegene Anyplex real-time PCR assay. Robust Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with HR-HPV in WLWH. RESULTS From January 2015 to March 2020, 868 WLWH and 134 women living without HIV (WLWoH) were tested for HR-HPV with prevalence of 50.9 and 38.1%, respectively ( P = 0.007). Among WLWH, 844 (97.4%) were antiretroviral therapy (ART)-experienced and 772 (89.7%) virally suppressed 1000 copies/ml or less. The most frequent HR-HPV types among WLWH were HPV-16 (13.5%), HPV-52 (9.5%), and HPV-35 (9.3%). HR-HPV infection was more common among Tanzanian WLWH (adjusted RR: 1.23, 95% CI 1.05-1.44, P = 0.012). Also, WLWH with CD4 + T cells of less than 200 cell/μl had 1.51-fold increased risk of having HR-HPV (95% CI 1.23-1.86, P < 0.001). CONCLUSION HR-HPV was common in WLWH in four African countries, particularly among women with low CD4 + cell count. Scale up of HPV vaccines and development of vaccines with broader activity against less common HR-HPV types may improve cervical cancer prevention in Africa.
Collapse
Affiliation(s)
- Mkunde Chachage
- National Institute for Medical Research-Mbeya Medical Research Centre
- University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Ajay P. Parikh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Anifrid Mahenge
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Wilbert Mbuya
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Ruby Mcharo
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Centre
| | | | - Reginald Gervas
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- U.S. Army Medical Research Directorate – Africa, Kericho
| | - Valentine Singoei
- U.S. Army Medical Research Directorate – Africa, Kisumu
- HJF Medical Research International, Kisumu, Kenya
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Abiola Fasina
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Jaclyn Hern
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Xiaofang Song
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| |
Collapse
|
2
|
Tawe L, Ramatlho P, Ketlametswe R, Koobotse M, Robertson ES, Grover S, Ramogola-Masire D, Paganotti GM. Cervical human papillomavirus genotypes in a high HIV setting: A scoping review of a decade of human papillomavirus epidemiological research in Botswana. Front Med (Lausanne) 2022; 9:1020760. [PMID: 36507502 PMCID: PMC9729273 DOI: 10.3389/fmed.2022.1020760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Cervical cancer burden is still high in low- and middle-income countries, including Botswana. Persistent human papillomavirus (HPV) infection is the leading cause of cervical cancer. Accurate knowledge of HPV diversity associated to cervical cancer in sub-Saharan Africa may provide accurate understanding of the natural history of HPV infection in these contexts. The goal of this review was to consolidate existing evidence on cervical HPV infection and to conduct a pooled analysis of data from all eligible Botswana studies. After a successful review of twelve studies on cervical HPV genotypes that met the inclusion criteria, HPV-16 genotype was the most frequently discovered in women with pre-cancerous and cancer lesions, followed by HPV-18. HPV-16 in HIV-positive women with precancerous lesions to cancer is between 45% and 47.7%, and between 4.5% and 26.1% for HPV-18. With reference to other HPV genotypes, the proportion of HPV-35 and HPV-58 (13-16%) seems relatively consistent among the studies, however HPV-58 appears to be more common in HIV-positive subjects compared to HIV-negative women. Indeed, HPV-45 seems to be frequently detected in women with cervical cancer compared to women with precancerous lesions. Regarding the low-risk HPV genotypes, an appropriate breakdown has been provided. In conclusion, the current prophylactic vaccines against HPV-16 and HPV-18, which have demonstrated good immunogenicity in HIV-infected populations, may still prevent infection and ultimately cancer.
Collapse
Affiliation(s)
- Leabaneng Tawe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Pleasure Ramatlho
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | | | - Moses Koobotse
- School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Erle S. Robertson
- Department of Otorhinolaryngology - Head and Neck Surgery, The Tumor Virology Program, Abramson Comprehensive Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Doreen Ramogola-Masire
- Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana,Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana,*Correspondence: Giacomo M. Paganotti,
| |
Collapse
|
3
|
Glasmeyer L, Mcharo RD, Torres L, Lennemann T, Danstan E, Mwinuka N, Judick M, Mueller W, Mbuya W, Hölscher M, Lellé R, Geldmacher C, Kroidl A, France JR. Long-term follow-up on HIV infected and non-infected women with cervical cancer from Tanzania: staging, access to cancer-directed therapies and associated survival in a real-life remote setting. BMC Cancer 2022; 22:892. [PMID: 35971100 PMCID: PMC9377112 DOI: 10.1186/s12885-022-09966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Worldwide 85% of cervical cancer (CC) related deaths occur in low- and middle-income countries. Sub-Saharan Africa is burdend by an overlapping high incidence of CC as well as HIV infection, a risk factor for HPV associated disease progression. Recent upscaling of CC screening activities increased the number of CC diagnoses in a previous unscreened population. The aim of the 2H study was to follow up on women with CC in the context of available health care services in Tanzania in relation to their HIV infection status. Methods This longitudinal observational cohort study included women with histological confirmed CC from Mbeya, Tanzania, between 2013–2019. All women were referred for CC staging and cancer-directed therapies (CDT), including surgery and/or radio-chemotherapy, or palliative care. Annual follow-up focused on successful linkage to CDT, interventions and survival. We assessed factors on compliance, used Kaplan–Meier-Survivor functions to evaluate survival time and poisson regression models to calculate incidence rate ratios on mortality (IRR) two years after diagnosis. Results Overall, 270 women with CC (123 HIV infected) were included. Staging information, available in 185 cases, showed 84.9% presented with advanced stage disease (FIGO ≥ IIB), no difference was seen in respect to HIV status. HIV-infected women were 12 years younger at the time of cancer diagnosis (median age 44.8 versus 56.4 years, p < 0.001). Median follow up period was 11.9 months (range 0.2–67.2). Survival information, available in 231 cases, demonstrated for women diagnosed in early-stage disease a median survival time of 38.3 months, in advanced-stage 16.0 months and late-stage disease 6.5 months after diagnosis. Of all women, 42% received CDT or palliative support. HIV co-infection and education were associated with higher health care compliance. CDT was significantly associated with lower 2-year mortality rates (IRR 0.62, p = 0.004). HIV coinfection did not impact mortality rates after diagnosis. Conclusion High numbers of advanced and late staged CC were diagnosed, compliance to CDT was low. A beneficial impact of CDT on CC mortality could be demonstrated for local health care services. This study indicates challenges for successful linkage and supports an effective scale up of cancer care and treatment facilities.
Collapse
Affiliation(s)
- Laura Glasmeyer
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ruby Doryn Mcharo
- Mbeya Medical Research Center (MMRC), National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - Liset Torres
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Tessa Lennemann
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,Mbeya Medical Research Center (MMRC), National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - Elizabeth Danstan
- Mbeya Medical Research Center (MMRC), National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - Nice Mwinuka
- Mbeya Medical Research Center (MMRC), National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - Mona Judick
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - William Mueller
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Wilbert Mbuya
- Mbeya Medical Research Center (MMRC), National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - Michael Hölscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Ralph Lellé
- Division of Gynecology, University of Muenster, Muenster, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - John Rwegoshora France
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania.
| |
Collapse
|