[Accepted Manuscript] Epidemiology of High-risk Human Papillomavirus and Cervical Lesions in African women living with HIV/AIDS: Effect of Anti-Retroviral Therapy.

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Kelly, H.A. ; Sawadogo, B. ; Chikandiwa, A. ; Segondy, M. ; Gilham, C. ; Lompo, O. ; Omar, T. ; Didelot, M.N. ; Nagot, N. ; Meda, N. ; Weiss, H.A. ; Delany-Moretlwe, S. ; Mayaud, P. ; HARP Study Group, . (2016)
  • Publisher: Lippincott, Williams & Wilkins
  • Related identifiers: doi: 10.1097/QAD.0000000000001301
  • Subject:
    mesheuropmc: female genital diseases and pregnancy complications

: To describe the effect of antiretroviral therapy (ART) and HIV-related factors on high-risk human papillomavirus (HR-HPV) and high-grade cervical intraepithelial neoplasia lesions (CIN2+) among women living with HIV/AIDS (WLHA) in sub-Saharan Africa.<br/> : Prospective cohort of WLHA in Ouagadougou, Burkina Faso (BF) and Johannesburg, South Africa (SA). Recruitment was stratified by ART status.<br/> : At baseline and endline (median 16 months), cervical samples, and biopsies were analyzed for HPV genotyping (InnoLiPA) and by histology. Logistic regression was used to estimate associations of ART and HIV-related factors with HR-HPV and CIN2+ outcomes, and all results presented are adjusted for baseline CD4 cell count.<br/> : Among 1238 enrolled WLHA (BF = 615; SA = 623), HR-HPV prevalence was 59.1% in BF and 79.1% in SA. CIN2+ prevalence was 5.8% in BF and 22.5% in SA. Compared with long-duration ART users (&gt;2 years), HR-HPV prevalence was higher among short-duration ART users [≤2 years; adjusted prevalence ratio (aPR) = 1.24, 95% confidence interval (CI) 1.04-1.47] in BF, and CIN2+ prevalence was higher among short-duration ART users [adjusted odds ratio (aOR) = 1.99, 95% CI 1.12-3.54) and ART-naive participants (aOR = 1.87, 95% CI 1.11-3.17) in SA. Among 963 (77.8%) women seen at endline, HR-HPV persistence was 41.1% in BF and 30.2% in SA; CIN2+ incidence over 16-months was 1.2% in BF and 5.8% in SA. HR-HPV persistence was associated with being ART-naive in BF (aPR = 1.89, 95% CI 1.26-2.83), and with short-duration ART use (aPR = 1.78, 95% CI 1.11-2.86) and HIV-1 plasma viral load at least 1000 copies/ml (aPR = 2.87, 95% CI 1.63-5.05) in SA. CIN2+ incidence was reduced among women on ART in SA (aOR = 0.39, 95% CI 0.15-1.01).<br/> : Prolonged and effective ART is important in controlling HR-HPV and the development of CIN2+.<br/>
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