|Authors||Bah Camara, H., Anyanwu, M., Drammeh, J., Njie, A., Mattiuzzo, G., Gillard, L., Wright, E. and Kimmitt, P.T.|
Background: Human papilloma virus (HPV) is known to be associated with cervical cancer (CC) and its precursors, squamous intraepithelial lesions (SIL). Studies have shown that CC are higher amongst human immunodeficiency virus (HIV) infected women and is often more aggressive and difficult to treat in this group. The extent of this correlation is such that the CDC and WHO have included CC to the case definition of acquired immunodeficiency syndrome (AIDS). In the Gambia, the national HIV sero-prevalence is 1.9%. However, HPV sero-prevalence amongst HIV positive women is unknown.
Study objectives: to determine HPV sero-prevalence, sero-conversion and persistence infection amongst a cohort of HIV positive women using a longitudinal study; to evaluate their attitudes towards safer sexual behaviours and the use of condoms in HIV prevention strategy.
Study design and population: HIV positive women (N = 28, Age 20- 49 yrs) with a CD4+ ≥500/mm3 participating in a bigger HPV prevalence study were recruited into a cohort and followed up for 18 months. Serum, Pap smear and epidemiological data on sexual behaviour were collected at baseline and at 9 months interval.
Methods: Serum samples were screened in triplicate against HPV 16, 18, 35, 51, 52 and 58 using pseudo-typed virus neutralisation assay. Presence of neutralising antibodies for each sample was determined as 50% inhibition of the HPV pseudotype infectivity. Cytology was carried out by two different cytologists and results confirmed by a pathologist.
Results: HPV sero prevalence was found to be 53.6% (15/28) at baseline. Of the 15 participants tested positive, 8 were positive with a single serotype with HPV 51 accounting for 20.0% (3/15), 13.3% (2/15) HPV 52, and 16, 18 and 58 each at 6.7% (1/15). Seven (7) women were sero positive with multiple HPV serotypes with HPV52 being prevalent.
Baseline cytology results showed 4 women with severe high grade squamous intraepithelial lesions (HSIL), positive for HPV 16 (2), HPV 51(2) with 1 with suspicion of CC invasion and 3women had low grade cervical lesions. Follow up results showed: 1 CC with HPV 51, 1 HSIL with persistence HPV 51, 2 HSIL with HPV 16 and 1 HSIL with persistent positivity with HPV 51/ 52.
Two participants sero-converted at 9 months and 6 remaining sero-negative participants were found still sero-negative at the 18 months follow up visit. Persistent and new infection at18 months were observed more with HPV serotype 52. Epidemiological baseline data on sexual behaviours showed participants do not use condom during sexual intercourse. Subsequent data on sexual behaviours during follow up showed no change in attitude towards safer sex
Conclusion: This data shows that other oncogenic HPV types order than HPV 16 may also be responsible for HSIL/CC and there is a need to strengthen the education on safer sex practices in the prevention of HIV and HPV in the Gambia.