Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America.
Jhpiego USA, Baltimore, MD, United States of America.
PLoS One. 2020 Feb 13;15(2):e0229086. doi: 10.1371/journal.pone.0229086. eCollection 2020.
The prevalence of high-risk human papillomavirus (hrHPV) is poorly described overall and in women living with HIV (WLWH) and HIV-negative women living in Botswana, a high HIV and cervical cancer-burden country. We conducted a pilot study of self-collection and high-risk HPV testing for cervical screening, from which data on HPV prevalence was available.
From five health facilities in the Kweneng East District, 1,022 women aged 30-49 years were enrolled to self-collect their cervicovaginal specimen for hrHPV testing by the Xpert HPV Test (Cepheid, Sunnyvale, CA, USA). Crude and age group-adjusted hrHPV prevalence by HIV status were calculated, and the relationship of hrHPV risk groups HPV16>HPV18/45>other hrHPV types) to the presence and severity of visible lesions.
Of the 1,022 women enrolled, 1,019 (99.7%), 570 WLWH and 449 HIV-negative women, had hrHPV testing results. Crude hrHPV prevalences were 25.2% (95%CI = 21.2-29.4%) for HIV-negative women and 40.4% (95%CI = 36.3-44.5%) for WLWH. Age group-adjusted hrHPV prevalences were 23.7% (95%CI = 19.9-27.9%) for HIV-negative women and 41.3% (95%CI = 37.2-45.4%) for WLWH. Age group-adjusted prevalences of HPV16 (p<0.001), HPV18/45 (p<0.001), HPV31/33/35/52/58 (p<0.001), and HPV39/56/66/68 (p = 0.011) were greater among WLWH than HIV-negative women. Riskier hrHPV groups were more likely to have visible abnormalities (ptrend = 0.004) and visible abnormalities not eligible for cryotherapy (ptrend = 0.030).
hrHPV infection was common among all women in the study living in Botswana, to a greater extent in WLWH than their HIV-negative counterparts. Strategies to triage hrHPV-positive women will be needed to avoid over-treating many women with benign hrHPV infections.
高危型人乳头瘤病毒（hrHPV）的流行情况总体上描述不佳，在感染人类免疫缺陷病毒（HIV）的妇女（WLWH）和博茨瓦纳 HIV 阴性妇女中也是如此，博茨瓦纳是一个 HIV 和宫颈癌负担沉重的国家。我们对自我采集和高危型 HPV 检测用于宫颈癌筛查进行了一项试点研究，从中获得了 HPV 流行率的数据。
从东昆嫩区的 5 家卫生机构中，招募了 1022 名年龄在 30-49 岁的妇女，由 Xpert HPV 检测（Cepheid，加利福尼亚州桑尼维尔）进行自我采集宫颈阴道标本，用于检测高危型 HPV。根据 HIV 状况计算了 HPV 感染的粗率和年龄组调整的 HPV 感染率，并分析了高危型 HPV 风险组（HPV16>HPV18/45>其他高危型 HPV 类型）与可见病变的存在和严重程度的关系。
在纳入的 1022 名妇女中，1019 名（99.7%）、570 名 WLWH 和 449 名 HIV 阴性妇女进行了高危型 HPV 检测。HIV 阴性妇女的 HPV 感染粗率为 25.2%（95%CI=21.2-29.4%），WLWH 的 HPV 感染率为 40.4%（95%CI=36.3-44.5%）。HIV 阴性妇女和 WLWH 的 HPV 感染年龄组调整率分别为 23.7%（95%CI=19.9-27.9%）和 41.3%（95%CI=37.2-45.4%）。HPV16（p<0.001）、HPV18/45（p<0.001）、HPV31/33/35/52/58（p<0.001）和 HPV39/56/66/68（p=0.011）在 WLWH 中的感染率高于 HIV 阴性妇女。更危险的高危型 HPV 组更有可能出现可见异常（趋势检验 p<0.001）和不适合冷冻治疗的可见异常（趋势检验 p=0.030）。
高危型 HPV 感染在博茨瓦纳研究中的所有妇女中都很常见，在 WLWH 中比 HIV 阴性妇女更为常见。需要制定策略对高危型 HPV 阳性妇女进行分层，以避免过度治疗许多感染良性高危型 HPV 的妇女。
