Naicker Nivashnee, Osman Farzana, Naidoo Kunthi, Bodley Nicola, Mbambo Nokuthandwa, Madlala Sibongile, Mhlongo Thobile, Mbatha Nomfundo, Maphumulo Andile, Munatsi Pedzisai, Radebe Precious, Liebenberg Lenine, Dorward Jienchi, Drain Paul K, Garrett Nigel
University of KwaZulu-Natal, Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
University of KwaZulu-Natal, Centre for the Aids Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa.
Sex Transm Infect. 2025 Apr 15;101(3):187-190. doi: 10.1136/sextrans-2024-056129.
Human papillomavirus (HPV) can cause cervical cancer, a leading cause of female cancer mortality in South Africa and worldwide. We assessed the burden of, and factors associated with, HPV infection using a molecular assay and cervical cytology among women living with HIV (WLHIV) in South Africa.
In this cross-sectional analysis, WLHIV initiating antiretroviral therapy (ART) underwent cervical Xpert HPV testing and liquid-based cytology. The Xpert test detects 14 high-risk (hr) HPV types reported in a pooled qualitative result. We evaluated clinical and sociodemographic variables and proportions between women testing positive and negative for hr-HPV, compared cytology with hr-HPV results and assessed associations with HPV positivity.
We enrolled 260 WLHIV, median age 31.0 (IQR 26.0-38.0) years. Overall, 91.3% of women were never screened for cervical cancer previously and none received HPV vaccination. In total, 67.3% (175/260) of women tested positive for any hr-HPV type, of which HPV16 and HPV18/45 were detected in 17.3% (45/260) and 22.7% (59/260) of women, respectively, and 56.5% (147/260) tested positive for 11 other hr-types. Of 258 WLHIV, 33.3% (86/258) had abnormal cytology: high-grade squamous intraepithelial lesion (SIL) 7.8% (20/258), low-grade SIL 24.0% (62/258) and atypical squamous cells of undetermined significance 1.6% (4/258). Of these, 93.0% (80/86) tested positive for hr-HPV: 30.0% (24/80) for HPV16, 31.3% (25/80) for HPV18/45 and 92.5% (74/80) for other hr-HPV types. Having a CD4 count<200 cells/µL was associated with hr-HPV infection (adjusted prevalence ratio 2.24; 95% CI 1.69 to 2.99 (p<0.001)).
hr-HPV infection and cervical abnormalities are common among WLHIV starting ART, especially those with low CD4 counts, highlighting that early HIV testing and treatment initiation must be prioritised together with cervical cancer screening. The diversity of hr-HPV types suggests a need for vaccines with expanded HPV type coverage in this setting.
人乳头瘤病毒（HPV）可引发宫颈癌，这是南非及全球女性癌症死亡的主要原因。我们采用分子检测法和宫颈细胞学检查，评估了南非感染艾滋病毒女性（WLHIV）中HPV感染的负担及相关因素。
在这项横断面分析中，开始接受抗逆转录病毒治疗（ART）的WLHIV接受了宫颈Xpert HPV检测和液基细胞学检查。Xpert检测可在汇总定性结果中检测出14种高危（hr）HPV类型。我们评估了临床和社会人口统计学变量以及hr-HPV检测呈阳性和阴性的女性之间的比例，将细胞学检查结果与hr-HPV检测结果进行比较，并评估与HPV阳性的相关性。
我们纳入了260名WLHIV，中位年龄为31.0（IQR 26.0 - 38.0）岁。总体而言，91.3%的女性此前从未接受过宫颈癌筛查，且无人接种过HPV疫苗。共有67.3%（175/260）的女性检测出任何一种hr-HPV类型呈阳性，其中分别有17.3%（45/260）和22.7%（59/260）的女性检测出HPV16和HPV18/45呈阳性，56.5%（147/260）的女性检测出其他11种hr-HPV类型呈阳性。在258名WLHIV中，33.3%（86/258）有细胞学异常：高级别鳞状上皮内病变（SIL）占7.8%（20/258），低级别SIL占24.0%（62/258），意义不明确的非典型鳞状细胞占1.6%（4/258）。其中，93.0%（80/86）的hr-HPV检测呈阳性：HPV16占30.0%（24/80），HPV18/45占31.3%（25/80），其他hr-HPV类型占92.5%（74/80）。CD4细胞计数<200个/µL与hr-HPV感染相关（调整后的患病率比为2.24；95%CI为1.69至2.99（p<0.001））。
在开始接受ART的WLHIV中，hr-HPV感染和宫颈异常情况较为常见，尤其是CD4计数低的患者，这突出表明必须将早期艾滋病毒检测和治疗启动以及宫颈癌筛查作为优先事项。hr-HPV类型的多样性表明在这种情况下需要扩大HPV类型覆盖范围的疫苗。
