Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Frequent detection of HPV before and after initiation of antiretroviral therapy among HIV/HSV-2 co-infected women in Uganda

TitleFrequent detection of HPV before and after initiation of antiretroviral therapy among HIV/HSV-2 co-infected women in Uganda
Publication TypeJournal Article
Year of Publication2013
AuthorsRositch, AF, Gravitt, PE, Tobian, AA, Newell, K, Quinn, TC, Serwadda, D, Ssebbowa, P, Kiggundu, V, Gray, RH, Reynolds, SJ
JournalPLoS One
ISBN Number1932-6203 (Electronic)1932-6203 (Linking)
Accession Number23383171
KeywordsAcyclovir/ therapeutic use, Age Factors, Anti-HIV Agents/therapeutic use, Cervix Uteri/virology, Coinfection/ epidemiology, Female, Genotype, Herpes Genitalis/ drug therapy/ epidemiology, HIV Infections/drug therapy/ epidemiology, Humans, Papillomavirus Infections/ epidemiology/genetics, Prevalence, Regression Analysis, Sexual and Reproductive Health, Uganda/epidemiology, Viral Load

OBJECTIVES: Most data on HPV and antiretroviral therapy (ART) come from high-resource countries with infrequent sampling for HPV pre- and post-ART initiation. Therefore, we examined the frequency of cervical HPV DNA detection among HIV/HSV-2 co-infected women followed monthly for 6 months both before and after initiation of ART in Rakai, Uganda. METHODS: Linear Array was used to detect 37 HPV genotypes in self-collected cervicovaginal swabs from 96 women who initiated ART. Random-effects log-binomial regression was used to compare the prevalence of HPV detection in the pre- and post-ART periods and determine other potential risk factors, including CD4 counts and HIV viral load. RESULTS: Nearly all women had detectable HPV in the 6 months preceding ART initiation (92%) and the cumulative prevalence remained high following initiation of therapy (90%). We found no effect of ART on monthly HPV DNA detection (prevalence ratio: 1.0; 95% confidence interval: 0.96, 1.08), regardless of immune reconstitution or HIV viral suppression. Older age and higher pre-ART CD4 counts were associated with a significantly lower risk of HPV DNA detection. CONCLUSIONS: ART did not impact HPV detection within 6 months of therapy initiation, highlighting the importance of continued and consistent screening, even after ART-initiation and immune reconstitution.