Title : Human papillomavirus types by cervical dysplasia, HIV-status and the diagnostic value of cervical screening methods in Eastern Kenya
Abstract:
Background: Human papillomavirus (HPV) causes over 99% of all cervical cancer globally. In 2022, it was responsible for over 3200 deaths in Kenya. Data on the epidemiological distribution of HPV genotypes by cervical dysplasia and HIV status which is important in designing prevention strategies and monitoring treatment of cervical cancer is lacking in Eastern Kenya.
Objective: The study aims to determine HPV type’s prevalence, diagnostic value of primary and sequential triage tests, and awareness of cervical cancer among HIV-infected and non-infected women aged 18-48 years in Eastern Kenya.
Methods: HPV genotyping, Pap smear, and VIA tests were conducted on the cervical transformation zone, squamocolumnar junction, and endocervical canal exudates, with social-demographic and awareness data collected using a questionnaire. Statistical relationships between laboratory outcomes and questionnaire data were computed using SPSS software.
Results: 317 women (161 (50.8%) HIV-positive and 156 (49.2%) HIV-negative, mean age: 34.3, range 18-46 years) were recruited. Of these, 27.4% (21.5% HIV-positive and 5.9% HIV-negative) had abnormal VIA (81/317 (25.6%)), HPV-genotyping (84/317 (26.5%)), Pap smear (96/317 (30.2%)), and histology (78/122 (63.9%)) test. A wide spectrum of HPV types was detected by CIN2+ (HIV-positive: HPV81 (18/317 (5.6%)) and HPV11 (3/317 (0.9%)); and Invasive cervical cancer: (HIV-positive: HPV16 (1/317 (0.3%)); HIV-negative: HPV16 (1/317 (0.3%)). HPV genotyping and Pap smear tests showed high diagnostic accuracy and specificity in HIV-infected women, with increased specificity in both primary and triage testing approaches. High awareness of cervical cancer disease was established, but it lacks understanding of its causes, signs, symptoms, and risk factors.
Conclusions: The study reveals higher HPV type frequency in HIV-infected women, with non-vaccine HPV types linked to cervical dysplasia, highlighting the need for accurate cervical screening methods. High cervical dysplasia is likely due to inadequate and inaccurate understanding of cervical cancer disease and risk factors.
