Comparative HPV genotype distribution among women with normal and abnormal cervical cytology in Yaoundé, Cameroon

Background: The epidemiology of human papillomavirus (HPV) infection and the pattern of HPV genotype distribution are parameters needed to assess the risk of cervical cancer. Oncogenic HPV types are well-known pathogen for lower genital tract neoplasias, representing the primary cause of cancer death in Africa and the second in Cameroon. This study was conducted to identify the various genotypes particularly the high-risk HPV types in normal and abnormal cervical cytology from women in Yaoundé, Cameroon. Methodology: This was a hospital-based, analytical cross-sectional study carried out on 226 symptomatic women wherein cervico-vaginal samples were obtained during gynaecological examination for Pap smears, HPV-DNA and genotype detection with linear array HPV strip, conducted from November 2019 to January 2021. Results: From the 226 women whose cervical samples were collected for Pap smears, 71 (31.4%) had abnormal cytology results while 155 (68.6%) had normal results. The overall HPV prevalence in the study population was 34.1% (77/226). The HPV prevalence in women with abnormal Pap smears was 100% (71/71) and are distributed in following descending order; LSIL (21.1%, 15/71), HSIL (21.1%, 15/71), ASC-US (19.7%, 14/71), ICC (19.7%, 14/71) and others (18.4%, 13/71). HPV-DNA was positive in 6 (3.9%) of the 155 women with normal cytology results, 4 (2.6%) of whom were high-risk HPV. There is statistically significant difference in the HPV prevalence between women with abnormal and normal Pap smear results (OR=3289, 95% CI=182.62-59235, p<0.0001). The frequently identified oncogenic HPV types were type 16 (31.2%, 24/77), type 45 (14.3%, 11/77) and type 18 (10.4%, 8/77). Conclusion: It is evident from our study that symptomatic women with normal Pap smear can have HR-HPV infection and should therefore be screened for HPV and followed up with periodic Pap smears to detect any abnormal change in cervical cytology results, to prevent cervical cancer development. Women should be encouraged to take up cervical screening, through Pap smears, because it is a non-invasive and cost-effective method for early detection of preinvasive lesions

Prevalence and distribution of cervical high-risk human papillomavirus infection in a rural community of Edo State, Nigeria

Background: Human papillomaviruses (HPVs) are non-enveloped, double-stranded DNA viruses and most women in the world are probably infected with at least one type of the virus during their sexual life. Oncogenic HPVs are predominantly sexually-transmitted pathogens and several high-risk types are associated with nearly all cases of cervical cancer worldwide. In view of paucity of data on the prevalence and distribution of various high risk HPV subtypes, this study was carried out to provide evidence based local data for cervical cancer preventive programs within this region. Methodology: This was a descriptive cross-sectional study involving 145 consenting women living in Ugbegun rural community of Edo central senatorial district, Edo State, Nigeria. Informed consent of each participant was obtained and socio-demographic information collected through interviewer-administered collection tool. Cervical swab sample was collected using the female cervical cell collection kit for HPV DNA testing. HPV DNA was detected by the Hybribio 21 HPV Geno array test kit which uses polymerase chain reaction (PCR) amplification and flow through hybridization assay. Summary statistics were presented as mean, standard deviation, median, frequency and proportions as appropriate using the Statistical Package for the Social Sciences (SPSS) version 22.0. Association of sociodemographic characteristics of the women with HPV prevalence was done using the 't' test, with p value less than 0.5 considered statistical significance. Results: Twenty four of the 145 women tested positive, giving HPV prevalence of 16.6%. Six HPV serotypes were detected; types 16, 18, 35, 45, 52 and 58. HPV types 16 and 18 were most frequent, contributing 54.2%, and coinfection occurred in 29.2%. HPV-positive women had significantly higher mean number of life time sexual partners (p=0.046) and mean parity (p=0.0001) compared to HPV-negative women. The mean age of the women (p=0.710), mean age at menarche (p=0.570) and mean age at coitarche (p=0.940) were not significantly associated with prevalence of HPV Conclusion: This study showed predominance of oncogenic cervical HPV types 16 and 18 within this sub region of rural Nigeria. Strengthening reproductive and sexual education in both males and females with focus on HPV vaccination, delaying sexual activities and reduction in number of child birth are strategies which could prevent high risk HPV infection and cervical cancer in rural communities

Recognition of infants at high risk for vertical HIV transmission at delivery in rural Western Cape Province, South Africa

Despite South Africa's substantial reduction in vertical HIV transmission (VHT), national paediatric HIV elimination is not yet attained. National and Western Cape Province (WC) HIV guidelines recommend enhanced postnatal prophylaxis for infants at high risk for VHT, identified in the WC 2015/2016 guidelines by any single high-risk criterion (maternal antiretroviral therapy (ART) <12 weeks, absent/ unsuppressed maternal HIV viral load (HIV-VL) <12 weeks before/including delivery, spontaneous preterm labour, prolonged rupture of membranes, chorioamnionitis). Accuracy of high-risk infant identification is unknown. Objectives. Primarily, to determine the proportion of infants at high risk for VHT, the accuracy of labour-ward risk classification, the criteria determining high-risk statuses and the criteria missed among unrecognised high-risk infants; secondarily, to determine maternal factors associated with high-risk infants. Methods. Infants born to women living with HIV at a rural regional hospital (May 2016 - April 2017) were retrospectively evaluated using data from the labour ward VHT register, standardised maternity case records, National Health Laboratory Service database and WC Provincial Health Data Centre. The study-derived risk status for each infant was determined using documented presence/absence of risk criteria and compared with labour ward assigned risk to determine accuracy. Proportions of high-risk and unrecognised high-risk infants with each high-risk criterion were determined. Maternal characteristics associated with having a high-risk infant were evaluated using multivariable logistic regression. Results. For liveborn infants, labour ward assigned risk classifications were 40% (n=75/188) high risk, 50% (n=94/188) low risk and 10% (n=19/188) unclassified. Study-derived risk was high risk for 69% (n=129/188) and low risk for 31% (n=59/188), yielding a high-risk classification sensitivity of 51% (95% confidence interval (CI) 42 - 60) and specificity of 69% (95% CI 56 - 80). Absent/unsuppressed HIVVL <12 weeks before delivery accounted for 83% (n=119/143) of study-derived high-risk exposures and 81% (n=60/74) of missed high-risk exposures. Fewer mothers of high-risk infants had >4 antenatal visits (38% v. 81%, p<0.01) and first antenatal visit <20 weeks' gestation (57% v. 77%, p=0.01). Only the number of antenatal visits remained associated with having a high-risk infant after adjusting for gestation at first visit and timing of HIV diagnosis and ART initiation: each additional antenatal visit conferred a 39% (95% CI 25 - 50) reduction in the odds of having a high-risk infant. Conclusion. Labour ward risk classification failed to recognise half of high-risk infants. Infant high-risk status as well as non-detection thereof were driven by suboptimal maternal HIV-VL monitoring. Reinforcing visit frequency later in pregnancy may improve antenatal HIV-VL monitoring, and point-of-care HIV-VL monitoring at delivery could improve recognition of virally unsuppressed mothers and their high-risk infants