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Incidence of conjunctival squamous cell carcinoma (cSCC) in Zimbabwe is >30-fold higher than the global average. cSCC risk is notably higher among people with human immunodeficiency virus, implicating impaired immune response and a yet unknown infectious etiology. Formalin-fixed, paraffin-embedded blocks from Zimbabwe, comprising conjunctival precancer (n = 78), invasive cSCC cases (n = 148) and nonmalignant eye lesions (n = 119), were tested for multiple DNA viruses using Luminex bead–based technology. Epstein-Barr virus (EBV) type 1 positivity was strongly associated with cSCC diagnosis (adjusted odds ratio [aOR], 5.6 [95% confidence interval {CI}, 3.0–10.4) and marginally associated with precancer (aOR, 2.1 [95% CI, 1.0–4.5]). On analyzing EBV transcriptional activity with any of LMP1, EBNA1, and BZLF1, RNA transcripts were detected in 5 of 112 controls, 3 of 67 precancers, and 10 of 139 cases and none were associated with conjunctival case status. Our EBV DNA data suggest that EBV may play a role in cSCC. However, the low detection rate of EBV RNA supports further investigation to infer causality. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccination programs are a key intervention in protecting individuals against HPV-related disease. HIV1-infected individuals are at increased risk of HPV-associated cancers. This study was conducted to evaluate the potential role of prophylactic HPV vaccines in preventing new HPV infections among participants with perinatally acquired HIV who received the quadrivalent HPV vaccine at least five years before this study. Methods: This cross-sectional study was conducted at Newlands Clinic, Harare, Zimbabwe. The clinic provided the Gardasil quadrivalent HPV vaccine (4vHPV) to 624 adolescents living with HIV starting in December 2015. Vaginal and penile swabs were collected and tested for HPV types from the study participants who had received the 4vHPV vaccine 5–6 years before enrolment. Results: We present the results of 98 participants (44.6% female) vaccinated at a median age of 15 years (IQR 12–16). The mean amount of time since vaccination was 6 years (SD: ±0.4). The HPV-positive rate amongst the analyzed swabs was 69% (68/98). Among 30/98 (31%) HPV-positive participants, 13/98 (13%) had low-risk HPV types, and 17/98 (17%) had high-risk HPV types. Twelve participants tested positive for HPV18, only one participant tested positive for HPV16, and an additional four (4.3%) tested positive for either type 6 or 11, with respect to vaccine-preventable low-risk HPV types. Conclusion: The Gardasil quadrivalent HPV vaccine (4vHPV) was expected to protect against infection with HPV types 16, 18, 6, and 11. We demonstrated a possible waning of immunity to HPV18 in 17% of the participants, and an associated loss in cross-protection against HPV45. We observed a relatively high prevalence of 'opportunistic non-vaccine HPV types' or 'ecological niche occupiers' in this cohort, and suggest further research on the involvement of these types in cervical and other genital cancers. Our study is one of the few, if not the first, to report on HPV vaccine immunoprotection among people living with HIV (PLWH), thereby setting a baseline for further studies on HPV vaccine effectiveness among PLWH. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Sample Measurements Results Conclusion To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe.Community‐based cross‐sectional survey.840 rural women (25–65 years).A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self‐reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables.Of the 840 women included, 33% had a history of screening. Women 25–45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30–0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45–0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03–2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22–2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47–13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02–5.86) had increased odds of CC screening.There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) types differ by geographic location and the ethnicity of the human host, which may have implications for carcinogenicity. HPV35 is one of the least frequently identified high-risk types in North America and Europe but was the most common high-risk HPV (hrHPV) infection in a cohort in rural Zimbabwe. Whole genome analysis is limited for HPV35; no such studies have been performed in Zimbabwe. Of 648 women in the initial cohort in Zimbabwe, 19 (19/648, 2.9%) tested positive for HPV35, and eight samples were successfully sequenced for HPV35. The maximum number of sequence variants for the whole genome was 58 nucleotides (0.7%) compared to the prototype (58/7879). The maximum number of sequence variants in E6 and E7 was 3 (3/450, 0.7%) 2 (2/300, 0.7%), respectively. These are the first HPV35 whole genome sequences from Zimbabwe, and these data further lend support to the carcinogenicity of HPV35 despite limited sequence heterogeneity. Further studies to determine carcinogenic effects and impact of HPV vaccinations are warranted, especially in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV (WLWH) are six times more likely to develop cervical cancer (CC). There is also an increased incidence of CC in women with optimal HIV disease control, despite immune reconstitution due to antiretroviral therapy (ART). Objectives: This study describes the prevalence and age-specific genotype distribution of hrHPV among an urban cohort of WLWH. Additionally, we report the HIV disease profile and age-specific outcomes of hrHPV DNA screening in WLWH attending routine CC screening at Newlands Clinic, Harare, between January and December 2021. Method: This was a descriptive cross-sectional design based on a retrospective review of records of WLWH who were screened for hrHPV infection. We assessed the prevalence of hrHPV infection during the study period. Results: We included data for 2745 women who had an hrHPV DNA test. The median age at the time of testing was 45 years (interquartile range [IQR]; 37-52) The median duration on HIV ART was 10.2 years (IQR: 6.2-13.3). The proportion of women with undetectable viral loads (< 50 copies/mL) was 91.2%. The prevalence of hrHPV infection was 53%. The most prevalent genotypes were human papillomavirus (HPV) 58 (11%), HPV 52 (10%), HPV 35 (10%), and HPV 16 (9%). Conclusion: Our study reports a high prevalence of HPV and hrHPV including other subtypes than 16 and 18. These results highlight the continued importance of CC screening and prophylactic HPV vaccinations among WLWH. [ABSTRACT FROM AUTHOR]

Background Age-specific data on anal, and corresponding cervical, human papillomavirus (HPV) infection are needed to inform female anal cancer prevention. Methods We centrally reanalyzed individual-level data from 26 studies reporting HPV prevalence in paired anal and cervical samples by human immunodeficiency virus (HIV) status and age. For women with HIV (WWH) with anal high-grade squamous intraepithelial lesions or worse (HSIL+), we also investigated concurrent cervical cytopathology. Results In HIV-negative women, HPV16 prevalence decreased significantly with age, both at anus (4.3% at 15–24 years to 1.0% at ≥55 years; ptrend = 0.0026) and cervix (7.4% to 1.7%; ptrend < 0.0001). In WWH, HPV16 prevalence decreased with age at cervix (18.3% to 7.2%; ptrend = 0.0035) but not anus (11.5% to 13.9%; ptrend = 0.5412). Given anal HPV16 positivity, concurrent cervical HPV16 positivity also decreased with age, both in HIV-negative women (ptrend = 0.0005) and WWH (ptrend = 0.0166). Among 48 WWH with HPV16-positive anal HSIL+, 27 (56%) were cervical high-risk HPV-positive, including 8 with cervical HPV16, and 5 were cervical HSIL+. Conclusions Age-specific shifts in HPV16 prevalence from cervix to anus suggest that HPV infections in the anus persist longer, or occur later in life, than in the cervix, particularly in WWH. This is an important consideration when assessing the utility of cervical screening results to stratify anal cancer risk. [ABSTRACT FROM AUTHOR]