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Type-Specific Human Papillomavirus Prevalence, Incident Cases, Persistence, and Associated Pregnancy Outcomes Among HIV-Infected Women in Kenya

Vyankandondera, Joseph MD*; Wambua, Sammy MSc; Irungu, Eunice RN; Mandaliya, Kishor MD†‡; Temmerman, Marleen PhD†§¶; Ryan, Claire PhD*∥; Mohamed, Yasmin MPH*∥; Vanden Broeck, Davy PhD¶**††; Verhelst, Rita PhD‡‡; Chersich, Matthew F. PhD¶§§; Luchters, Stanley MD, PhD*§¶∥

doi: 10.1097/OLQ.0000000000001029
Original Studies
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Background Persistent infection with high-risk types of human papillomavirus (HPV) is the preeminent factor driving the development of cervical cancer. There are large gaps in knowledge about both the role of pregnancy in the natural history of HPV infection and the impact of HPV on pregnancy outcomes.

Methods This single-site prospective cohort substudy, nested within an international multisite randomized controlled trial, assessed prevalence, incident cases, and persistence of type-specific HPV infection, and the association between persistence of high-risk HPV infection with pregnancy outcomes among HIV-infected pregnant women in Kenya, including HIV transmission to infants. Type-specific HPV was assessed using a line probe assay in pregnancy and again at 3 months after delivery. HIV status of children was determined using polymerase chain reaction at 6 weeks.

Results In total, 84.1% (206/245) of women had a high-risk HPV infection at enrollment. Three quarters (157/206) of these infections persisted postpartum. Persistence of HPV16 and/or HPV18 types was observed in more than half (53.4%; 39/73) of women with this infection at enrollment. Almost two-thirds had an incident high-risk HPV infection postpartum, which was not present in pregnancy (62.5%), most commonly HPV52 (19.0%). After adjustments, no association was detected between persistent high-risk HPV and preterm birth. All mothers of the 7 cases of infant HIV infection had persistent high-risk HPV infection (P = 0.044).

Conclusions High levels of high-risk HPV infection and type-specific persistence were documented, heightening the urgency of mass role out of HPV vaccination. The association between HPV persistence and HIV transmission is a novel finding, warranting further study.

A study of HIV-infected women tested for human papillomavirus (HPV) during pregnancy and 3 months postpartum showed high persistence and incidence of high-risk HPV and an association between HPV and HIV infection in infants.

From the *Burnet Institute, Melbourne, Australia;

International Centre for Reproductive Health;

Coast Provincial General Hospital, Mombasa;

§Aga Khan University, Nairobi, Kenya;

International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium;

Monash University, Melbourne, Australia;

**Ambior, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp;

††National Reference Centre for HPV, Brussels;

‡‡Ghent University, Ghent, Belgium;

§§Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

J. Vyankandondera is now with the United Nations Fund for Population, Côte d'Ivoire.

R. Verhelst is now with HoGent, Department of Biomedical Sciences, Ghent, Belgium.

S. Wambua is now with Pwani University Bioscience Research Centre, Kilifi, Kenya.

Acknowledgments: The authors would like to acknowledge the contribution of the members of the Kesho Bora Study Group as well as all the women who participated.

Conflict of Interest and Sources of Funding: The authors have no conflict of interest to declare. The Mombasa site was funded by Agence Nationale de Recherche sur le Sida, World Health Organization (WHO) Special Programme in Human Reproduction (HRP) European and Developing Countries Clinical Trials Partnership, Thrasher Research Fund, and Belgian Directorate General for International Cooperation. The overall coordination and external monitoring was funded by WHO/HRP. Representatives of Agence Nationale de Recherche sur le Sida, Centers for Disease Control and Prevention, National Institutes of Health, and WHO/HRP were involved in study design and collection, analysis, and interpretation of data. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors also acknowledge the contribution of the Victorian Operational Infrastructure Support Program received by the Burnet Institute to this work and the Research Foundation—Flanders (3GA13210).

Correspondence: Stanley Luchters, MD, PhD, Department of Population Health, Faculty of Health Sciences, Aga Khan University, 3rd Parklands Ave, Nairobi, Kenya. E-mail: stanley.luchters@aku.edu.

Received for publication November 20, 2018, and accepted May 9, 2019.

Online date: June 11, 2019

© Copyright 2019 American Sexually Transmitted Diseases Association