Original Research

Confronting the human papillomavirus–HIV intersection: Cervical cytology implications for Kenyan women living with HIV

James M. Kangethe, Stephen Gichuhi, Eddy Odari, Jillian Pintye, Kenneth Mutai, Leila Abdullahi, Alex Maiyo, Marianne W. Mureithi
Southern African Journal of HIV Medicine | Vol 24, No 1 | a1508 | DOI: https://doi.org/10.4102/sajhivmed.v24i1.1508 | © 2023 James Mburu Kangethe, Stephen Gichuhi, Eddy Odari, Jillian Pintye, Kenneth Mutai, Leila Abdullahi, Alex Maiyo, Marianne W. Mureithi | This work is licensed under CC Attribution 4.0
Submitted: 27 May 2023 | Published: 27 October 2023

About the author(s)

James M. Kangethe, Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya and; Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya and; Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
Stephen Gichuhi, Department of Ophthalmology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
Eddy Odari, Department of Medical Microbiology, Faculty of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
Jillian Pintye, Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States
Kenneth Mutai, Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
Leila Abdullahi, Research and Policy Development, African Institute for Development Policy, Nairobi, Kenya
Alex Maiyo, Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
Marianne W. Mureithi, Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya and; KAVI Institute of Clinical Research, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya

Abstract

Background: High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV.

Objectives: We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV.

Method: We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya’s national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations.

Results: We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7–14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3–4.1, P = 0.005).

Conclusion: Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.


Keywords

high-risk human papillomavirus; cervical cytology; cervical cancer; women living with HIV; antiretroviral therapy; Kenya

Sustainable Development Goal

Goal 3: Good health and well-being

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