Prevalence of High-Risk Human Papillomavirus (HPV) Genotypes 16 and 18 among HIV-Positive Women with Abnormal Cervical Cytology at Machakos Level 5 Hospital, Kenya
Onesmus Muia Mutuku *
Department of Medical Laboratory Sciences, School of Health Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya.
Scholastica Gatwiri Mathenge
Department of Medical Laboratory Sciences, School of Health Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya.
Titus Kamau Karuga
Department of Medical Laboratory Sciences, Karatina University, P.O. BOX 1957—10101, Karatina, Kenya.
Kyama Cleophas Mutinda
Department of Medical Laboratory Sciences, School of Biomedical Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya.
*Author to whom correspondence should be addressed.
Abstract
Aims: To determine the prevalence of high-risk human papillomavirus (HPV) genotypes 16 and 18 among HIV-positive women with abnormal cervical cytology at Machakos Level 5 Hospital, Kenya.
Study Design: A prospective cross-sectional study.
Place and Duration of Study: The Comprehensive Care Centre and Cancer Care and Research Centre, Machakos Level 5 Hospital, Machakos County, Eastern Kenya, from July to December 2020.
Methodology: Four hundred HIV-positive women aged 18 years and above attending the Comprehensive Care Centre were recruited. Cervical samples were collected using a cytobrush and processed using manual liquid-based cytology. Cytological findings were classified according to the 2014 Bethesda System. Residual samples from women with abnormal cervical cytology were preserved at −80°C and tested for HPV genotypes 16 and 18 using the HPV 16/18 Real-TM Quant real-time polymerase chain reaction assay. Data were analysed using the Statistical Package for the Social Sciences, with statistical significance set at P < 0.05.
Results: Among the 400 participants, 25 had abnormal cytological findings of atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma (SCC) and had samples available for HPV testing. HPV-16/18 DNA was detected in 18 (72.0%) participants, while neither HPV-16 nor HPV-18 DNA was detected in 7 (28.0%). Among the 18 participants with HPV-16/18 DNA detected, HPV type 16 was detected in 11 (61.1%), while HPV type 18 was detected in 7 (38.9%). HPV-16/18 DNA was detected in 6/9 (66.7%) women with ASC-US, 4/6 (66.7%) with LSIL, 1/2 (50.0%) with ASC-H, 6/7 (85.7%) with HSIL and 1/1 (100%) with SCC. The association between cytological findings and HPV-16/18 DNA status was not statistically significant (Fisher–Freeman–Halton exact test, P = 0.814).
Conclusion: High-risk HPV types 16 and 18 were highly prevalent among HIV-positive women with abnormal cervical cytological findings, with HPV 16 being the predominant genotype. The high prevalence supports the potential value of adjunctive HPV testing alongside cervical cytology in the screening and management of HIV-positive women.
Keywords: High-risk human papillomavirus, HPV-16, HPV-18, HIV-positive women, Abnormal cervical cytology, Cervical cytology, Cervical cancer screening, Cervical cancer, Manual Liquid-based cytology