High-Risk HPV Prevalence Nearly 28% Among Women Living with HIV in Addis Ababa, Study Finds
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A new study reveals a concerningly high prevalence of high-risk human papillomavirus (hrHPV) infection – 27.8% – among women living with HIV (WWH) in Addis Ababa, Ethiopia. The research, utilizing a retrospective review of screening data, underscores the urgent need for targeted cervical cancer prevention strategies within this vulnerable population.
Increased HPV Risk Linked to Immune Suppression
The study, conducted using the Abbott Real-Time hrHPV test (VIA), found that HPV16 and HPV18, the two most common globally prevalent hrHPV genotypes, accounted for 15.3% and 4% of infections, respectively. Though, a considerable 73.3% of detected infections where attributed to other high-risk genotypes – including 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.
Researchers suggest the elevated hrHPV prevalence among WWH is likely linked to immune suppression, which hinders the body’s ability to clear infections and can lead to reactivation of latent HPV. “This result might reflect the fact that hrHPV infection is more prevalent among WWH than in the general population,” the study authors noted.
Comparing Prevalence Rates Across Ethiopia and Rwanda
The 27.8% prevalence observed in Addis Ababa is higher than rates reported in other Ethiopian studies. Such as, a study in South Central Ethiopia found hrHPV prevalence to be 20.5% among the general population, while a separate study at Attat Hospital reported a rate of 16%. However, the Addis Ababa findings align with a 26.5% hrHPV prevalence identified in a study conducted in Rwanda.
The variation in prevalence rates highlights the influence of geographic location and socioeconomic factors on HPV infection.
Younger Women and Marital status Show Correlation with infection
The study revealed a significant association between age and hrHPV positivity. Women aged 25-29 years were more likely to test positive for hrHPV compared to those between 40 and 49 years. This finding is consistent with other research demonstrating higher infection rates in younger age groups,who might potentially be more susceptible due to recent HPV exposure and less developed immune responses.
Interestingly, married and widowed women exhibited lower odds of hrHPV infection compared to divorced women. This observation mirrors findings from studies in Italy and Ghana, suggesting a potential link between marital status and HPV risk.
Cervical Lesion Detection and STI History
Following positive hrHPV tests, women underwent VIA screening to detect cervical lesions. 15.5% of those who tested positive for hrHPV also showed VIA-positive results, indicating the presence of precancerous changes. This rate is comparable to a 13.1% prevalence of cervical lesions found in a study in the Amhara region of Ethiopia. However, it is higher than rates observed in studies that did not initially screen for hrHPV, such as a 9.3% prevalence reported in North-Western Ethiopia.
A history of sexually transmitted infections (STIs) was significantly associated with an increased likelihood of having a cervical lesion diagnosed by VIA – women with a history of STI were 1.69 times more likely to have lesions. This connection is likely due to the shared transmission routes of hrHPV and other STIs,and also increased cervical inflammation associated with STIs,which can lead to false-positive VIA results.
Study Strengths and Limitations
The study’s strength lies in it’s large sample size, drawn from 16 pilot health facilities across Addis ababa, enhancing the representativeness of the findings. Though, researchers acknowledged limitations, including the inability of the Abbott Real-Time hrHPV test to differentiate between specific HPV genotypes beyond HPV 16 and 18. Additionally,the absence of data on factors such as age at first intercourse,number of sexual partners,CD4 count,and viral load in the registration logbooks limited the scope of the analysis.
Despite these limitations, this research provides critical insights into the burden of hrHPV infection and associated cervical lesions among WWH in Addis Ababa, emphasizing the need for comprehensive and targeted prevention and screening programs.
