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Human Papillomavirus Genotypes in Invasive Cervical Carcinoma in HIV Seropositive and Seronegative Women in Zimbabwe

Washington Muodini, Joael Michael Palefnsky, Martin John Hale, Michael Zvavahera Chirenje, Rudo Tanyaradzwa Makunike-Mutasa, Fiona Mutisi, Alltalents Murahwa and Mario Altini

Background: Invasive cervical carcinoma (ICC) accounts for 23% of all cancer-related deaths in Zimbabwean women. Trials for a national program of genotype-specific HPV vaccines are underway to prevent cervical carcinoma, but the distribution of HPV types among women with ICC according to HIV status is unknown.
Methods: To determine prevalence and distribution of high-risk HPV genotypes by HIV status in women with ICC, we performed a cross-sectional study on women referred for ICC testing at four urban referral hospitals in Zimbabwe from June 2014-December 2015. Cervical biopsies were obtained for histology and HPV genotyping. HIV serology testing was performed. HPV testing was performed using MY09/MY11 PCR followed by typing using dot blot hybridization.
Results: Of 107 participants with histologically-proven, HIV prevalence was 49.5% (53/107). HIV-positive women tended to be younger (median age 44 years) than HIV-negative women (median age 59 years). HPV prevalence was 94% (101/107), ranging from 1-5 genotypes per participant. HPV 16 (81.5%), 18 (24%), 33 (13%), 35 (11%), 56 (9%) and 45(7.4%) were the most prevalent genotypes amongst HIV-negative participants; HPV 16 (67.9%), 18 (43.4%), 56 (18.9%), 45 (15.1%), 33 (11.3%), and 58 (9.4%) were most prevalent amongst HIV-positive participants. 83% of women were infected with either HPV-16 or HPV-18.
Conclusion: Effective vaccination programs against HPV 16 and 18 could prevent up to 83% of cases of cervical cancer in Zimbabwe. HIV may influence distribution of some HPV genotypes given the significant increase in prevalence of HPV 18 amongst HIV positive participants.