Abstract:
Women living with HIV in Africa are at increased risk to be co-infected with Human Papilloma Virus (HPV),
persistent high risk (HR) HPV infection and bacterial vaginosis (BV), which compounds HPV persistence, thereby
increasing the risk for cervical dysplasia. New guidance from WHO in 2014 advocating for a “screen and treat”
approach in resource poor settings is becoming a more widely recommended screening tool for cervical cancer
prevention programs in such contexts. This review article summarizes the risk factors to be considered when
designing a primary and secondary cervical prevention program in a post-vaccination era for HIV-infected
women in Kenya.
This review article is based on our prior research on the epidemiology of pHR/HR-HPV genotypes in HIV-
infected women and CIN 2 + in Kenya and other sub-Saharan contexts. In order to contextualize the findings, a
literature search was carried out in March 2017 by means of four electronic databases: PUBMED, EMBASE,
SCOPUS, and PROQUEST.
Risk factors for potential (pHR)/HR HPV acquisition, including CD4 count, HAART initiation, Female Sex
Worker status (FSW) and BV need to be considered. Furthermore, there may be risk factors for abnormal cy-
tology, including FSW status, multiple potential (p)HR/HR HPV genotypes, which may require that HIV-infected
women be subjected to screening at more frequent intervals than the three year recommended by the WHO. The
quadruple synergistic interaction between HIV, HPV and BV and its related cervicitis may need to be reflected
within a larger prevention framework at the community level. The opportunities brought forth by the roll out of
HAART could lead to task shifting of HIV-HPV-BV care to nurses, which may increase access in poorly-served
areas.
