Epidemiology and Health

Systematic Review

Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review: Jude Ogechukwu Okoye, Chukwudi Amaechi Ofodile, Oluwaseun Kelechi Adeleke, Okechi Obioma; Epidemiol Health. 2021;43:e2021039. Published online May 25, 2021; DOI: https://doi.org/10.4178/epih.e2021039

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Abstract

OBJECTIVES
This review assessed the rate of high-risk human papillomavirus (HPV) infection among women living in sub-Saharan Africa. It also determined the prevalence of high-risk HPV (hrHPV) among human immunodeficiency virus (HIV) seropositive (HIV+) and seronegative (HIV-) women in sub-Saharan Africa, pre-2010 and post-2010.

METHODS

In this systematic review, Google Scholar, PubMed Central, and Embase were searched to identify cohort and case-control studies that investigated the relationship between HIV and HPV infection. The database searches yielded 17 studies published between 1999 and 2018.

RESULTS

In the general population, the prevalence of any HPV/multiple HPV infections was higher among HIV+ (53.6/22.6%) than among HIV- women (26.5/7.3%) with odds ratios of 3.22 and 3.71, respectively (95% confidence interval, 3.00 to 3.42 and 2.39 to 5.75, p< 0.001). The prevalent HPV genotypes among HIV+ and HIV- women diagnosed with invasive cervical cancer (ICC) were HPV-16/18 and HPV-45. The prevalence of HPV-16, HPV-18, and HPV-45 was lower in 1999-2010 (3.8, 1.7, and 0.8%, respectively) than in 2011-2018 (19.1, 6.0, and 3.6%, respectively). Among women diagnosed with ICC, HIV+ women had a higher prevalence of HPV-56, HPV-31, and HPV-51 (7.3, 5.3, and 3.3%, respectively) than HIV- women (1.3, 2.2, and 0.4%, p< 0.001, p= 0.050, and p= 0.013, respectively).

CONCLUSIONS

The prevalence of HPV infection, multiple HPV infections, and non-vaccine HPV types were higher among HIV+ women than among HIV- women in sub-Saharan Africa. Although HIV infection influences the distribution of HPV types, this study suggests that cervical cancer incidence in sub-Saharan Africa is primarily driven by the prevalence of vaccine hrHPVs, especially HPV-16 and HPV-18.

Summary

Key Message
Despite increasing awareness of Human papillomavirus (HPV) among women and availability of HPV vaccines, mounting evidence shows that the age-standardized incidence rate of cervical cancer is increasing in sub-Saharan Africa. This review revealed the influences of some viruses on the trends of the disease between 1999-2010 and 2011-2018.

Citations

Citations to this article as recorded by

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