Persistence and risk factors of high-risk human papillomavirus infection among HIV positive and HIV negative tanzanian women: a cohort study

Patricia Swai*, Vibeke Rasch, Ditte S. Linde, Bariki Mchome, Rachel Manongi, Chun Sen Wu, Marianne Waldstrom, Thomas Iftner, Julius Mwaiselage, Susanne K. Kjaer


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Background: High-risk (HR) human papillomavirus (HPV) persistence is the most important risk factor for cervical cancer. We have assessed the type-specific HR HPV persistence among HIV positive and HIV negative Tanzanian women and factors associated with HR HPV persistence. Methods: In a cohort study including 4080 Tanzanian women, 3074 attended follow-up examination (up to 32 months after enrollment). Cervical samples were obtained for liquid-based cytology and HPV DNA testing using Hybrid Capture 2 and Inno-Lipa Extra II. Information on lifestyle factors was collected through a personal interview. The probability of HR HPV persistence at a given time point since enrollment was estimated non-parametrically using the EMICM algorithm. Results: Among the 462 women HR HPV positive at enrollment, 158 had at least one identical type detected at follow-up. The probability of persistence at 18 months after enrollment was 34.2 (95% CI 29.0–39.4). Stratifying by HIV status, the persistence probability was 42.9% (95% CI 33.5–51.9) among HIV positive, and 28.0% (95% CI 22.1–34.2) among HIV negative. Overall, HR HPV persistence was most common for HPV58, 35, 16, 31, and 52. Among HIV positive women it was HPV45, and HPV16, followed by HPV58 and HPV18, and among HIV negative women it was HPV31, HPV33 and HPV58. Risk factors associated with persistence of HR HPV were older age, longer interval between enrollment and follow-up, binge drinking, and HIV status. Conclusions: HR HPV persistence was common in Tanzania, and most common among HIV positive women. Overall, persistence was most frequent for HPV 58, 35, 16, 31 and 52. The nonavalent HPV vaccine should be considered.

TidsskriftInfectious Agents and Cancer
Antal sider11
StatusUdgivet - 11. jun. 2022

Bibliografisk note

Funding Information:
We acknowledge the research assistants for their diligent data collection. We thank the staff at KCMC, Mawenzi and ORCI for their support during the study. We also thank senior statistician Kirsten Frederiksen for support with the statistical analysis. A special thank goes out to all women who consented and participated during the study follow up.

Funding Information:
SKK has previously received speaker fee from Merck and research grant from Merck through her affiliating institution. TI received speaker honoraria from Hologic GmbH and an unrestricted research grant to his institution from Hologic GmbH.

Funding Information:
The work was supported by Danish Ministry of Foreign affairs through the Danish International Development Agency (DANIDA), Danish Fellowship Centre (DFC) with grant no: 14-P02-Tan/A26775. The funders had no role in study design, data collection and analysis, decision to preparation or publish the manuscript.

Publisher Copyright:
© 2022, The Author(s).


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