Abstract:
Background Cervical cancer is caused by oncogenic human papillomaviruses (HR-HPV) and is common among Ken-
yan women. Identification of factors that increase HR-HPV persistence is critically important. Kenyan women exposed
to aflatoxin have an increased risk of HR-HPV detection in cervical specimens. This analysis was performed to examine
associations between aflatoxin and HR-HPV persistence.
Methods Kenyan women were enrolled in a prospective study. The analytical cohort for this analysis included 67 HIV-
uninfected women (mean age 34 years) who completed at least two of three annual study visits and had an available
blood sample. Plasma aflatoxin was detected using ultra-high pressure liquid chromatography (UHPLC)-isotope dilu-
tion mass spectrometry. Annual cervical swabs were tested for HPV (Roche Linear Array). Ordinal logistic regression
models were fitted to examine associations of aflatoxin and HPV persistence.
Results Aflatoxin was detected in 59.7% of women and was associated with higher risk of persistent detection of any
HPV type (OR = 3.03, 95%CI = 1.08–8.55, P = 0.036), HR-HPV types (OR = 3.63, 95%CI = 1.30-10.13, P = 0.014), and HR-
HPV types not included in the 9-valent HPV vaccine (OR = 4.46, 95%CI = 1.13–17.58, P = 0.032).
Conclusions Aflatoxin detection was associated with increased risk of HR-HPV persistence in Kenyan women. Further
studies, including mechanistic studies are needed to determine if aflatoxin synergistically interacts with HR-HPV to
increase cervical cancer risk