Genetic diversity in L1 ORF of human papillomavirus in women with cervical cancer with and without human immunodeficiency virus in Botswana and Kenya.

BACKGROUND: The variation of human papillomavirus (HPV) genotypes shapes the risks of cervical cancer and these variations are not well defined in Africa. Nucleotide changes within the L1 gene, nucleotide variability, and phylogeny were explored in relation to HIV in samples from Botswana and Kenya. METHODS: A total of 98 HPV-positive cervical samples were sequenced to identify different HPV variants. Phylogenetic inferences were used to determine HPV genotypes and investigate the clustering of sequences between women living with HIV (WLWHIV) and -women not living with HIV (WNLWHIV). RESULTS: Out of 98 generated sequences, 83.7% (82/98) participants had high-risk (HR) HPV genotypes while 16.3% (16/98) had low-risk (LR) HPV genotypes. Among participants with HR-HPV genotypes, 47.6% (39/82) were coinfected with HIV. The prevalence of HR-HPV genotypes was statistically higher in the Botswana population compared to Kenya (p-value < 0.001). Multiple amino acid mutations were identified in both countries. Genetic diversity differed considerably among WLWHIV and WNLWHIV. The mean pairwise distances between HPV-16 between HIV and HIV/HPV as well as for HPV-18 were statistically significant. Six (6) new deleterious mutations were identified in the HPV genotypes based on the sequencing of the L1 region, HPV-16 (L441P, S343P), HPV-18 (S424P), HPV-45 (Q366H, Y365F), and HPV-84 (F458L). The majority of the patients with these mutations were co-infected with HIV. CONCLUSIONS: Genomic diversity and different genomic variants of HPV sequences were demonstrated. Candidate novel mutations within the L1 gene were identified in both countries which can be further investigated using functional assays.

CRYOTHERAPY FOLLOWING VISUAL INSPECTION WITH ACETIC ACID AND LUGOL'S IODINE (VIA/VILI) IN KHWISERO, WESTERN KENYA: LESSON FROM THE FIELD AFFECTING POLICY AND PRACTICE.

BACKGROUND: Cervical cancer can be prevented and mortality/morbidity reduced by early detection and referral. Developing countries are likely to benefit from more cost effective methods of screening and treatment. Visual inspection with acetic acid and Lugol's iodine (VIA/VILI) offers a see and treat solution thus an affordable and efficient way to identify pre-malignant lesions. Immediate treatment with cryotherapy can be offered if pre-malignant lesions are found on visual inspection. Cryotherapyis a simple procedure that is curative for dysplasia; it is likely to benefit cervical dysplasia cases picked early in resource poor settings, however there are several factors that hinder patients' access to this noble technique. OBJECTIVE: Determine hindrances to cryotherapy for patients following positive results of VIA/VILI after referral. DESIGN: Cross sectional Study SETTING: Khwisero, Western Kenya. SUBJECTS: Women attending a medical camp, willing to get screened for cervical cancer. RESULTS: One hundred and nine patients were screened; seventy three (66.97%) were negative for VIA/VILI, twenty one (19.26%) were positive and referred for cryotherapy. Reasons for lack of follow up were financial constraints, lack of medical personnel at referral centres and poor access to the referral facilities.19.26% of women identified with positive lesions required intervention. No patient received cryotherapy following referral. CONCLUSION: There is urgent need for availability of cryotherapy machines and training of personnel who can perform cryotherapy at the primary care level. Regional studies on knowledge attitudes and practices about VIA/VILI and cryotherapy are required to provide reasons for the poor uptake of this procedure.