Happel Anna-Ursula, Budiawan Elvira, Onono Maricianah, Innes Steve, Palanee-Phillips Thesla, Heuvel Janine, Rakiep Adeebah, Kellow-Webb Sarah, Ongere Joan, Wakhungu Imeldah, Mkhize Zandile, Kapa La-Donna, Sigcu Nompumelelo, Dabee Smritee, Nair Gonasagrie, Scoville Caitlin, Mugo Nelly R, Williamson Anna-Lise, Passmore Jo-Ann S, Jaspan Heather B, Heffron Renee
Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Department of Pathology, University of Cape Town, Cape Town, South Africa.
Open Forum Infect Dis. 2024 Nov 22;11(12):ofae690. doi: 10.1093/ofid/ofae690. eCollection 2024 Dec.
Human papillomavirus (HPV) vaccines and DNA testing roll out in resource-constrained settings. We evaluated the natural history of HPV infections in African women to contribute to normative guidance.
Women aged 16 to 35 years were enrolled from 3 sites in South Africa and Kenya and followed quarterly for 18 months. A subset was recalled 5 years postenrollment, when Papanicolaou smears were conducted. Endocervical swabs were tested for 36 HPV genotypes by HPV Direct Flow. Logistic regression models identified correlations between demographic, biological, or behavioral factors and baseline high-risk HPV (HR-HPV).
At enrollment, 158 of 311 women (median age, 23 years; IQR, 20-27) had at least 1 HR-HPV genotype. HPV-52 (13.5%), HPV-16 (9.5%), HPV-58 (9.0%), HPV-18 (8.4%), and HPV-35 (8.4%) were most common. Coinfection with low-risk HPVs (odds ratio, 2.65; 95% CI, 1.59-4.45) were associated with HR-HPV positivity, while reported condom use (odds ratio, 0.57; 95% CI, .34-.98) and older age were protective. Of women with HR-HPV at enrollment, 87.3% cleared at least 1 HR-HPV infection over 18 months and 64.6% cleared all such infections. Few (1.9%) had evidence of high-grade cervical abnormalities, among which HPV-35 was the most prevalent during the study.
The high prevalence of HR-HPV emphasizes that HPV vaccination, screening, and testing campaigns in Africa are important. Nonvaccine HPV-35 was as common as HPV-18, suggesting the need to supplement current vaccines with this genotype. HR-HPV clearance was also common, highlighting that clear messaging is needed from health care providers to patients while discussing HPV DNA testing results.
人乳头瘤病毒（HPV）疫苗和DNA检测在资源有限的环境中推广。我们评估了非洲女性HPV感染的自然史，以提供规范性指导。
从南非和肯尼亚的3个地点招募16至35岁的女性，每季度随访18个月。一部分人在入组5年后被召回，进行巴氏涂片检查。通过HPV直接流式检测法检测宫颈拭子中的36种HPV基因型。逻辑回归模型确定了人口统计学、生物学或行为因素与基线高危HPV（HR-HPV）之间的相关性。
入组时，311名女性（中位年龄23岁；四分位间距，20 - 27岁）中有158名至少感染1种HR-HPV基因型。HPV-52（13.5%）、HPV-16（9.5%）、HPV-58（9.0%）、HPV-18（8.4%）和HPV-35（8.4%）最为常见。与低风险HPV共感染（比值比，2.65；95%置信区间，1.59 - 4.45）与HR-HPV阳性相关，而报告使用避孕套（比值比，0.57；95%置信区间，0.34 - 0.98）和年龄较大具有保护作用。入组时感染HR-HPV的女性中，87.3%在18个月内清除了至少1种HR-HPV感染，64.6%清除了所有此类感染。很少（1.9%）有高级别宫颈异常的证据，其中HPV-35在研究期间最为普遍。
HR-HPV的高流行率强调了非洲HPV疫苗接种、筛查和检测活动的重要性。非疫苗型HPV-35与HPV-18一样常见，表明需要用这种基因型补充当前疫苗。HR-HPV清除也很常见，突出了医疗保健提供者在讨论HPV DNA检测结果时需要向患者传达清晰信息。
