Abstract:
Background: HPV is the major etiological factor in the causal pathway for cervical cancer, which is the leading
cancer among women in sub-Saharan Africa. HIV is associated with a higher prevalence and a broader range of
high-risk HPV genotypes. Studies have shown a positive association between Bacterial vaginosis (BV) and HPV
and HIV. Also, in African women, BV was found to be significantly associated with vaginal inflammation. The high
prevalence of BV, HIV and HPV infections in the African continent makes elucidation of the interactions with one
another of utmost public health interest. The aims of the current study are to examine the frequency of HPV
genotypes and BV as well as their respective risk factors within an HIV infected population with abnormal cytology
in the resource-constrained setting of Mombasa, Kenya and, secondly, highlight issues to consider for triple
co-infection clinical management.
Method: Cross-sectional analysis with a sample drawn from an ongoing cohort study. All consenting, non-pregnant
HIV infected women, between 18 and 50 years of age, without a history of cervical cancer or hysterectomy, between
November 2005 and April 2006 were screened for HR HPV DNA in Mombasa, Kenya. 1 out of 4 HIV positive women
fulfilled the criteria by having SIL (24.9 %). 600 HIV infected women were tested to reach a cohort of 74 HIV women
with abnormal cytology. To assess which factors were associated with HR HPV, crude statistical analysis was performed
through logistic regression.
Results: Bacterial vaginosis (BV) was found in 46 women out of 74 (62.2 %). Cervicitis was diagnosed in 15 %
of women (n = 11), of which 8 had BV. The most prevalent HPV genotypes were HPV 16 (33.8), HPV 53 (24.3)
and HPV 18 (17.6 %), while 65 % of the participants had multiple genotype infection.
Statistically significant associations between CD4 counts <200 cells/μl and multiple HPV prevalence, adjusted
for age were also noted (OR = 3.7; 95 CI: 1.2–12.1; p = 0.03) and HPV53 (OR = 4.4, 95 % CI: 1.4–13.6; p = 0.01).
A statistically significant association was found between CD4 count ≥ 350 μl and HPV 16 adjusted for age
(OR = 2.9; 95 % CI: 1.0- 8.3; p = 0.05). A borderline statistically significant association was observed between
BV and HPV58 (crude OR = 4.1, 95 % CI: 0.8–21.0; p = 0.07).
