1. 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.
- Author
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Sinayobye, Jean d¿Amour, Sklar, Marc, Hoover, Donald R., Qiuhu Shi, Dusingize, Jean Claude, Cohen, Mardge, Mutimura, Eugene, Asiimwe-Kateera, Brenda, Castle, Philip E., Strickler, Howard, and Anastos, Kathryn
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HIV infections , *PAPILLOMAVIRUS diseases , *PAPILLOMAVIRUSES , *DISEASE prevalence , *EARLY detection of cancer ,CERVIX uteri tumors - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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