Prevalence and risk factors for High-Risk Human Papillomavirus (hrHPV) infection among HIV-infected and Uninfected Rwandan women: Implications for hrHPV-based screening in Rwanda

Jean d Amour Sinayobye, Marc Sklar, Donald R. Hoover, Qiuhu Shi, Jean Claude Dusingize, Mardge Cohen, Eugene Mutimura, Brenda Asiimwe-Kateera, Philip E. Castle, Howard Strickler, Kathryn Anastos

Research output: Contribution to journalArticle

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Abstract

Background: New World Health Organization guidelines recommend high-risk human papillomavirus (hrHPV) screen-and-treat strategies for cervical cancer prevention. We describe risk of, and risk factors for, testing hrHPV positive in a pilot study of hrHPV screen-and-treat conducted in Rwanda. Methods: A total of 2,964 women, 1,289 HIV-infected (HIV [+]) and 1,675 HIV-uninfected (HIV [-]), aged 30-60 years and living in Rwanda were enrolled in 2010. Cervical specimens were collected and tested by careHPV, a DNA test for a pool of 14 hrHPV types. Prevalence with binomial 95% confidence intervals (95% CI) and determinants of testing hrHPV positive were calculated. Results: hrHPV prevalence was higher in HIV [+] (31.8%, 95% CI = 29.2-34.4%) than HIV [-] women (8.2%, 95% CI = 6.7-9.8%; P < 0.0001). Among HIV [+] women, there was a significant trend (p<inf>trend</inf> <0.001) of higher hrHPV prevalence with lower CD4 cell count, with the highest hrHPV prevalence among those with <200 CD4 cell counts (45.5%, 95% CI = 34.8-56.4%). In multivariate analysis of HIV [+] women, testing hrHPV positive was positively associated CD4 count of <200 cells/μL, history of 3 or more sexual partners, and history of using hormonal contraception, and negatively associated with older age. In HIV [-] women, testing hrHPV positive was negatively associated only with older age groups of 45-49 and 50-60 years and surprisingly was not associated with lifetime number of sexual partners. Conclusion: hrHPV prevalence is high in HIV [+], especially in women with the lowest CD4 cell counts, which may have implications for utilizing hrHPV-based screening strategies such as screen-and-treat in these high-risk subgroups.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalInfectious Agents and Cancer
DOIs
StateAccepted/In press - Dec 8 2014

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Rwanda
Papillomavirus Infections
HIV
CD4 Lymphocyte Count
Confidence Intervals
Sexual Partners
HIV-1
Contraception

Keywords

  • Cervical cancer
  • HIV
  • HPV
  • Screening

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology
  • Epidemiology
  • Cancer Research

Cite this

Prevalence and risk factors for High-Risk Human Papillomavirus (hrHPV) infection among HIV-infected and Uninfected Rwandan women : Implications for hrHPV-based screening in Rwanda. / Sinayobye, Jean d Amour; Sklar, Marc; Hoover, Donald R.; Shi, Qiuhu; Dusingize, Jean Claude; Cohen, Mardge; Mutimura, Eugene; Asiimwe-Kateera, Brenda; Castle, Philip E.; Strickler, Howard; Anastos, Kathryn.

In: Infectious Agents and Cancer, 08.12.2014, p. 1-11.

Research output: Contribution to journalArticle

Sinayobye, Jean d Amour ; Sklar, Marc ; Hoover, Donald R. ; Shi, Qiuhu ; Dusingize, Jean Claude ; Cohen, Mardge ; Mutimura, Eugene ; Asiimwe-Kateera, Brenda ; Castle, Philip E. ; Strickler, Howard ; Anastos, Kathryn. / Prevalence and risk factors for High-Risk Human Papillomavirus (hrHPV) infection among HIV-infected and Uninfected Rwandan women : Implications for hrHPV-based screening in Rwanda. In: Infectious Agents and Cancer. 2014 ; pp. 1-11.
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abstract = "Background: New World Health Organization guidelines recommend high-risk human papillomavirus (hrHPV) screen-and-treat strategies for cervical cancer prevention. We describe risk of, and risk factors for, testing hrHPV positive in a pilot study of hrHPV screen-and-treat conducted in Rwanda. Methods: A total of 2,964 women, 1,289 HIV-infected (HIV [+]) and 1,675 HIV-uninfected (HIV [-]), aged 30-60 years and living in Rwanda were enrolled in 2010. Cervical specimens were collected and tested by careHPV, a DNA test for a pool of 14 hrHPV types. Prevalence with binomial 95{\%} confidence intervals (95{\%} CI) and determinants of testing hrHPV positive were calculated. Results: hrHPV prevalence was higher in HIV [+] (31.8{\%}, 95{\%} CI = 29.2-34.4{\%}) than HIV [-] women (8.2{\%}, 95{\%} CI = 6.7-9.8{\%}; P < 0.0001). Among HIV [+] women, there was a significant trend (ptrend <0.001) of higher hrHPV prevalence with lower CD4 cell count, with the highest hrHPV prevalence among those with <200 CD4 cell counts (45.5{\%}, 95{\%} CI = 34.8-56.4{\%}). In multivariate analysis of HIV [+] women, testing hrHPV positive was positively associated CD4 count of <200 cells/μL, history of 3 or more sexual partners, and history of using hormonal contraception, and negatively associated with older age. In HIV [-] women, testing hrHPV positive was negatively associated only with older age groups of 45-49 and 50-60 years and surprisingly was not associated with lifetime number of sexual partners. Conclusion: hrHPV prevalence is high in HIV [+], especially in women with the lowest CD4 cell counts, which may have implications for utilizing hrHPV-based screening strategies such as screen-and-treat in these high-risk subgroups.",
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T2 - Implications for hrHPV-based screening in Rwanda

AU - Sinayobye, Jean d Amour

AU - Sklar, Marc

AU - Hoover, Donald R.

AU - Shi, Qiuhu

AU - Dusingize, Jean Claude

AU - Cohen, Mardge

AU - Mutimura, Eugene

AU - Asiimwe-Kateera, Brenda

AU - Castle, Philip E.

AU - Strickler, Howard

AU - Anastos, Kathryn

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N2 - Background: New World Health Organization guidelines recommend high-risk human papillomavirus (hrHPV) screen-and-treat strategies for cervical cancer prevention. We describe risk of, and risk factors for, testing hrHPV positive in a pilot study of hrHPV screen-and-treat conducted in Rwanda. Methods: A total of 2,964 women, 1,289 HIV-infected (HIV [+]) and 1,675 HIV-uninfected (HIV [-]), aged 30-60 years and living in Rwanda were enrolled in 2010. Cervical specimens were collected and tested by careHPV, a DNA test for a pool of 14 hrHPV types. Prevalence with binomial 95% confidence intervals (95% CI) and determinants of testing hrHPV positive were calculated. Results: hrHPV prevalence was higher in HIV [+] (31.8%, 95% CI = 29.2-34.4%) than HIV [-] women (8.2%, 95% CI = 6.7-9.8%; P < 0.0001). Among HIV [+] women, there was a significant trend (ptrend <0.001) of higher hrHPV prevalence with lower CD4 cell count, with the highest hrHPV prevalence among those with <200 CD4 cell counts (45.5%, 95% CI = 34.8-56.4%). In multivariate analysis of HIV [+] women, testing hrHPV positive was positively associated CD4 count of <200 cells/μL, history of 3 or more sexual partners, and history of using hormonal contraception, and negatively associated with older age. In HIV [-] women, testing hrHPV positive was negatively associated only with older age groups of 45-49 and 50-60 years and surprisingly was not associated with lifetime number of sexual partners. Conclusion: hrHPV prevalence is high in HIV [+], especially in women with the lowest CD4 cell counts, which may have implications for utilizing hrHPV-based screening strategies such as screen-and-treat in these high-risk subgroups.

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