HUMAN PAPILLOMAVIRUS GENOTYPES IN WOMEN LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION ATTENDING ANTI-RETROVIRAL THERAPY CLINIC AT THE KORLE-BU TEACHING HOSPITAL, ACCRA

ABSTRACT

BACKGROUND: Annual global estimates show that 274,000 out of 490,000 women,

newly diagnosed with invasive cervical cancer caused by oncogenic types of human

papillomavirus (HPV), die. High risk HPV genotypes (hrHPV) cause the cancers whilst

the low risk genotypes cause benign lesions (warts). HIV infection increases the prevalence

and the persistence of hrHPV infection and human immunodeficiency virus (HIV) infected

women are eight times more likely of developing invasive cervical cancer as compared to

HIV negative women. There is currently paucity of data on the prevalent HPV genotypes

that affect HIV infected women in Ghana and West Africa.

AIM: The aim of this study was to determine the genotype distribution of HPV infection

in women living with HIV.

METHODOLOGY: This was a cross sectional study. A structured questionnaire was

used to obtain demographic information and the likelihood of HPV infection from women

of ages 18 years to 65 years attending Antiretroviral Therapy (ART) clinic at Korle-Bu

Teaching Hospital. Papanicolau (Pap) smears were done on all women and examined by a

cytologist. HPV DNA was extracted from their cervical cells and genotyped using a nested

multiplex polymerase chain reaction. Recent CD4+ count of these women were obtained

from their folders.

RESULTS: Hundred participants (mean age, 40.21 ± 8.44 years) took part in the study.

Seventeen HPV genotypes (12 high risk and 5 low risk) were detected by PCR. Overall

HPV prevalence was 61.4% of which the hrHPV genotype prevalence rate was 54%.

hrHPV 35 (12%) and HPV 42 (12%) were the most prevalent. Genotypes 16 (2%), 39

(2%), 59 (2%) and 56 (1%) were the least prevalent. There were 41% single HPV

infections and a total of 27% multiple HPV infections. Of the multiple infections, double

infections (14%) were the highest. For the multiple infections HPV genotypes 6, 11, 35,

68, 42, 45, 51, in descending order, were the most prevalent. For single infections,

genotypes 35, 42, 44, 52 and 45, in descending order, were the most prevalent. Smoking

was not a risk factor in this study. Majority of the women (84%) reported negative for

intraepithelial lesion or malignancy (NILM). Squamous cell lesions detected were lowgrade

squamous intraepithelial lesion (LSIL) [3%], high-grade squamous intraepithelial

lesion (HSIL) [2%], atypical squamous cells of undetermined significance (ASCUS) [1%]

and atypical squamous cells of undetermined significance - cannot exclude high grade

(ASC-H) [1%]. A total of six high risk and two low risk genotypes were detected in the

women who had squamous cell lesions. hrHPV genotypes 35, 45, 52 and 56 as well as 42

(low risk) were detected in (HSIL), hrHPV 35 and 44 (low risk) were detected in LSIL,

hrHPV45 was detected in ASC-H, genotypes 42 and 44 (low risk) and hrHPVs 51 and 66

were detected in ASCUS. Genital infections associated with HPV genotypes were bacteria

vaginosis (genotypes 6, 11, 42, 43, 44 and hrHPV 16, 18, 35, 66, 68), vaginitis (hrHPV

52), atrophic vaginitis (hrHPV 39) and candidiasis (hrHPV 45). Bacteria vaginosis was the

most prevalent infection (16%). Most of the women (64%) had their CD+4 count > 350

cells/mm3

CONCLUSION: HPV genotypes in Ghanaian women living with HIV were determined.

A total HPV prevalence of 61.4% was observed. hrHPV 35 (12%) and HPV 42 (12%) were

the most prevalent genotypes. HPV genotypes were detected in all the squamous lesions;

LSIL (3%), HSIL (2%), ASCUS (1%) and ASC-H (1%), detected. Multiple hrHPV

genotypes 35, 45, 52 and 56 were detected in HSIL and 42 and 44 (all low risk) and

hrHPV66 were detected in ASCUS.