Type-specific Human Papillomavirus and Its Association With Human T Lymphotropic Virus-1 Among Women Accessing HIV Care at Kenyatta National Hospital

Abstract

Background Cervical cancer is a serious disease with a global annual mortality of 311,000, particularly affecting low and middle-income countries, including Kenya where the mortality rate is 27 deaths per 10,000 women. Women living with HIV (WLHIV) are susceptible to high-risk Human Papillomavirus (HR-HPV) and Human T-Lymphotrophic virus-1 (HTLV-1) infections among others due to compromised immunity. HR-HPV and HTLV-1 are associated with the causation of cervical cancer and adult T-cell lymphoma respectively. WLHIV also have a lower chance of clearing HPV infection resulting in persistence. There is limited data on HR-HPV distribution and progression and co-infections with HTLV-1 among WLHIV. Objective This study aimed to determine the distribution of type-specific HR-HPV genotypes and their correlation with HTLV-1 among women accessing HIV care at Kenyatta National Hospital (KNH), Kenya. Method A prospective cohort study of women accessing HIV care at KNH was conducted. Participants were recruited from the HIV clinic. Cervical specimens were obtained for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM and for cytology to check for cervical epithelial abnormalities. Blood samples were collected for HTLV-1 DNA detection. Follow-up included re-screening for HR-HPV after 12 months. Data analysis was performed using SPSS version 23.0 at a significance level of P ≤ 0.05. Results were reported as proportions with 95% confidence intervals. Descriptive statistics were presented as frequencies for categorical variables and as mean or median values for continuous variables. Data analysis focused on HR-HPV and HTLV-1 co-infections as the primary outcome. Bivariate analysis explored factors associated with abnormal cytology. A multivariate logistic model adjusted for potential confounders. Results A total of 647 women accessing HIV care were enrolled, with a mean age of 42.8 years (SD = 8.7) and a mean age of sexual debut of 18.3 years (SD = 3.0). Majority (97.2%, n=629) were on antiretroviral treatment (ART) with 79% (n=496) achieving viral suppression (<50 copies/ml plasma). There were 224 women with HR-HPV infections (34.6%) of which 190 (29.4%) were 9-valent-vaccine-preventable, the commonest being types 52 in 86 participants (38.4%), 16 in 64 (28.6%) and 18 in 53 (23.7%)...