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Sex Transm Infect. Aug 2001; 77(4): 248–254.
PMCID: PMC1744347

The interrelation of HIV, cervical human papillomavirus, and neoplasia among antenatal clinic attenders in Tanzania


* Died April 2000

Objectives: To determine the prevalence and interrelation of cervical human papillomavirus (HPV) genotypes, squamous intraepithelial lesions (SIL), HIV, and other reproductive tract infections (RTIs) among urban antenatal clinic attenders in Mwanza, Tanzania.

Methods: Genital swabs were collected from 660 pregnant women and tested for a range of RTIs and for cervical cytology. Cervical HPV-DNA was detected by PCR and genotyped. HIV and syphilis serologies were performed.

Results: HPV prevalence was 34% (209/612 women). Of the 144 typeable samples, 83% were high risk (HR-HPV) oncogenic strains (56% HPV 16 related types). SIL was detected in 43 women (7%), with high grade SIL in 3%. There was a high prevalence of HIV (15%), and of any RTI (83%). Genital warts were detected in 20 women (3%). HPV infection was associated with some behavioural factors (short duration of relationship, single status, not using condoms) and gonorrhoea. There was no overall association between HPV and HIV (OR=1.02, 95% CI 0.6–1.6), but a non-significant trend towards a stronger association with HR-HPV in women aged 15–19 (OR=2.79, 95% CI 0.8–9.5) and women aged ≥30 (OR=3.20, 95% CI 0.7–15). SIL was associated with HPV (OR=3.66, 95% CI 1.9–7.0), but not significantly with HIV (OR=1.54, 95% CI 0.7–3.4). Prevalence of SIL was higher among women dually positive for HPV/HIV compared to HPV infection only (21% v 12%), although this difference was not statistically significant (p=0.17).

Conclusions: HPV infection was highly prevalent in this young antenatal population. The association of HIV with HR-HPV types in older women may suggest that the principal HIV/HPV interaction in this population is for HIV to upregulate HPV persistence, leading to subsequent development of SIL.

Key Words: human papillomavirus; squamous intraepithelial lesion; HIV/AIDS; Africa

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Selected References

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  • Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999 Mar 15;80(6):827–841. [PubMed]
  • Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Muñoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999 Sep;189(1):12–19. [PubMed]
  • Van Ranst M, Kaplan JB, Burk RD. Phylogenetic classification of human papillomaviruses: correlation with clinical manifestations. J Gen Virol. 1992 Oct;73(Pt 10):2653–2660. [PubMed]
  • Lorincz AT, Reid R, Jenson AB, Greenberg MD, Lancaster W, Kurman RJ. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol. 1992 Mar;79(3):328–337. [PubMed]
  • ter Meulen J, Eberhardt HC, Luande J, Mgaya HN, Chang-Claude J, Mtiro H, Mhina M, Kashaija P, Ockert S, Yu X, et al. Human papillomavirus (HPV) infection, HIV infection and cervical cancer in Tanzania, east Africa. Int J Cancer. 1992 Jun 19;51(4):515–521. [PubMed]
  • Newton R, Grulich A, Beral V, Sindikubwabo B, Ngilimana PJ, Nganyira A, Parkin DM. Cancer and HIV infection in Rwanda. Lancet. 1995 May 27;345(8961):1378–1379. [PubMed]
  • La Ruche G, You B, Mensah-Ado I, Bergeron C, Montcho C, Ramon R, Touré-Coulibaly K, Welffens-Ekra C, Dabis F, Orth G. Human papillomavirus and human immunodeficiency virus infections: relation with cervical dysplasia-neoplasia in African women. Int J Cancer. 1998 May 18;76(4):480–486. [PubMed]
  • Goedert JJ, Coté TR, Virgo P, Scoppa SM, Kingma DW, Gail MH, Jaffe ES, Biggar RJ. Spectrum of AIDS-associated malignant disorders. Lancet. 1998 Jun 20;351(9119):1833–1839. [PubMed]
  • Serraino D, Carrieri P, Pradier C, Bidoli E, Dorrucci M, Ghetti E, Schiesari A, Zucconi R, Pezzotti P, Dellamonica P, et al. Risk of invasive cervical cancer among women with, or at risk for, HIV infection. Int J Cancer. 1999 Jul 30;82(3):334–337. [PubMed]
  • Mayaud P, Uledi E, Cornelissen J, ka-Gina G, Todd J, Rwakatare M, West B, Kopwe L, Manoko D, Grosskurth H, et al. Risk scores to detect cervical infections in urban antenatal clinic attenders in Mwanza, Tanzania. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S139–S146. [PubMed]
  • Evans DM, Hudson EA, Brown CL, Boddington MM, Hughes HE, Mackenzie EF, Marshall T. Terminology in gynaecological cytopathology: report of the Working Party of the British Society for Clinical Cytology. J Clin Pathol. 1986 Sep;39(9):933–944. [PMC free article] [PubMed]
  • Richart RM. A modified terminology for cervical intraepithelial neoplasia. Obstet Gynecol. 1990 Jan;75(1):131–133. [PubMed]
  • Gravitt PE, Peyton CL, Apple RJ, Wheeler CM. Genotyping of 27 human papillomavirus types by using L1 consensus PCR products by a single-hybridization, reverse line blot detection method. J Clin Microbiol. 1998 Oct;36(10):3020–3027. [PMC free article] [PubMed]
  • van den Brule AJ, Meijer CJ, Bakels V, Kenemans P, Walboomers JM. Rapid detection of human papillomavirus in cervical scrapes by combined general primer-mediated and type-specific polymerase chain reaction. J Clin Microbiol. 1990 Dec;28(12):2739–2743. [PMC free article] [PubMed]
  • Laurence J, Friedman SM, Chartash EK, Crow MK, Posnett DN. Human immunodeficiency virus infection of helper T cell clones. Early proliferative defects despite intact antigen-specific recognition and interleukin 4 secretion. J Clin Invest. 1989 Jun;83(6):1843–1848. [PMC free article] [PubMed]
  • Spinillo A, Tenti P, Zappatore R, De Seta F, Silini E, Guaschino S. Langerhans' cell counts and cervical intraepithelial neoplasia in women with human immunodeficiency virus infection. Gynecol Oncol. 1993 Feb;48(2):210–213. [PubMed]
  • Tornesello ML, Buonaguro FM, Beth-Giraldo E, Giraldo G. Human immunodeficiency virus type 1 tat gene enhances human papillomavirus early gene expression. Intervirology. 1993;36(2):57–64. [PubMed]
  • Arany I, Evans T, Tyring SK. Tissue specific HPV expression and downregulation of local immune responses in condylomas from HIV seropositive individuals. Sex Transm Infect. 1998 Oct;74(5):349–353. [PMC free article] [PubMed]
  • Kreiss JK, Kiviat NB, Plummer FA, Roberts PL, Waiyaki P, Ngugi E, Holmes KK. Human immunodeficiency virus, human papillomavirus, and cervical intraepithelial neoplasia in Nairobi prostitutes. Sex Transm Dis. 1992 Jan-Feb;19(1):54–59. [PubMed]
  • Laga M, Icenogle JP, Marsella R, Manoka AT, Nzila N, Ryder RW, Vermund SH, Heyward WL, Nelson A, Reeves WC. Genital papillomavirus infection and cervical dysplasia--opportunistic complications of HIV infection. Int J Cancer. 1992 Jan 2;50(1):45–48. [PubMed]
  • Langley CL, Benga-De E, Critchlow CW, Ndoye I, Mbengue-Ly MD, Kuypers J, Woto-Gaye G, Mboup S, Bergeron C, Holmes KK, et al. HIV-1, HIV-2, human papillomavirus infection and cervical neoplasia in high-risk African women. AIDS. 1996 Apr;10(4):413–417. [PubMed]
  • Piper MA, Severin ST, Wiktor SZ, Unger ER, Ghys PD, Miller DL, Horowitz IR, Greenberg AE, Reeves WC, Vernon SD. Association of human papillomavirus with HIV and CD4 cell count in women with high or low numbers of sex partners. Sex Transm Infect. 1999 Aug;75(4):253–257. [PMC free article] [PubMed]
  • Vernon SD, Unger ER, Piper MA, Severin ST, Wiktor SZ, Ghys PD, Miller DL, Horowitz IR, Greenberg AE, Reeves WC. HIV and human papillomavirus as independent risk factors for cervical neoplasia in women with high or low numbers of sex partners. Sex Transm Infect. 1999 Aug;75(4):258–260. [PMC free article] [PubMed]
  • Seck AC, Faye MA, Critchlow CW, Mbaye AD, Kuypers J, Woto-Gaye G, Langley C, De EB, Holmes KK, Kiviat NB. Cervical intraepithelial neoplasia and human papillomavirus infection among Senegalese women seropositive for HIV-1 or HIV-2 or seronegative for HIV. Int J STD AIDS. 1994 May-Jun;5(3):189–193. [PubMed]
  • Motti PG, Dallabetta GA, Daniel RW, Canner JK, Chiphangwi JD, Liomba GN, Yang L, Shah KV. Cervical abnormalities, human papillomavirus, and human immunodeficiency virus infections in women in Malawi. J Infect Dis. 1996 Mar;173(3):714–717. [PubMed]
  • Temmerman M, Tyndall MW, Kidula N, Claeys P, Muchiri L, Quint W. Risk factors for human papillomavirus and cervical precancerous lesions, and the role of concurrent HIV-1 infection. Int J Gynaecol Obstet. 1999 May;65(2):171–181. [PubMed]
  • Serwadda D, Wawer MJ, Shah KV, Sewankambo NK, Daniel R, Li C, Lorincz A, Meehan MP, Wabwire-Mangen F, Gray RH. Use of a hybrid capture assay of self-collected vaginal swabs in rural Uganda for detection of human papillomavirus. J Infect Dis. 1999 Oct;180(4):1316–1319. [PubMed]
  • La Ruche G, Leroy V, Mensah-Ado I, Ramon R, You B, Bergeron C, Mothebesoane-Anoh S, Touré-Coulibaly K, Dabis F. Short-term follow up of cervical squamous intraepithelial lesions associated with HIV and human papillomavirus infections in Africa. Int J STD AIDS. 1999 Jun;10(6):363–368. [PubMed]
  • Vernon SD, Reeves WC, Clancy KA, Laga M, St Louis M, Gary HE, Jr, Ryder RW, Manoka AT, Icenogle JP. A longitudinal study of human papillomavirus DNA detection in human immunodeficiency virus type 1-seropositive and -seronegative women. J Infect Dis. 1994 May;169(5):1108–1112. [PubMed]
  • Sun XW, Kuhn L, Ellerbrock TV, Chiasson MA, Bush TJ, Wright TC., Jr Human papillomavirus infection in women infected with the human immunodeficiency virus. N Engl J Med. 1997 Nov 6;337(19):1343–1349. [PubMed]
  • Parkin DM, Wabinga H, Nambooze S, Wabwire-Mangen F. AIDS-related cancers in Africa: maturation of the epidemic in Uganda. AIDS. 1999 Dec 24;13(18):2563–2570. [PubMed]
  • Chabaud M, Le Cann P, Mayelo V, Leboulleux D, Diallo AS, Enogat N, Afoutou JM, Anthonioz P, Coll-Seck AM, Coursaget P. Detection by PCR of human papillomavirus genotypes in cervical lesions of Senegalese women. J Med Virol. 1996 Aug;49(4):259–263. [PubMed]
  • Burk RD, Ho GY, Beardsley L, Lempa M, Peters M, Bierman R. Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis. 1996 Oct;174(4):679–689. [PubMed]

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