Prevalence and factors associated with high-risk human papillomavirus infection and cervical lesions among women with HIV in Addis Ababa, Ethiopia

BACKGROUND: In Ethiopia, the Human Papillomavirus (HPV) type distribution is still not well characterized among women with Human Immunodeficiency Virus (HIV). This study aimed to assess the prevalence of HPV infection, determine the distribution of HPV genotypes, and examine the rate of abnormal findings from visual inspection with acetic acid (VIA) among HPV-positive women living with HIV (WWH) in Addis Ababa, Ethiopia. It also analyzed the factors associated with these findings. METHODOLOGY: A retrospective record review was conducted at 16 HPV-DNA testing health facilities in Addis Ababa, Ethiopia. A total of 3303 WWH were screened for HPV infection through self- and clinician-based cervical swab collection from April 2021 to January 2022, all were included in the study. WWH were offered HPV testing at antiretroviral therapy (ART) clinics. Trained nurses invited women positive for high-risk HPV (hrHPV) types for VIA screening. Women with suspicious lesions were referred to gynaecologic centres, and others were appointed for a follow-up visit after one year. Associations between independent variables and HPV-DNA as well as VIA positivity were assessed using Binary logistic regression. RESULT: The prevalence of hrHPV infection was 28.7% (95% CI: 27.2, 30.3%). Of those, 145 (15.3%) had HPV 16, and 38 (4%) had HPV 18 and the rest larger proportion was "other high-risk HPV" accounted for 695 (73.3%). The data showed that 70 (7.4%) women had multiple hrHPV infection, meaning ≥ 2 HPV DNA types were found in a single sample. This study found that the odds of women aged 25-29 being infected with hrHPV was 68% higher than those of women aged 40-49 (Adjusted Odds Ratio (AOR) = 1.68, 95% CI 1.26, 2.22). Women who were married and widowed had lower odds of hrHPV infection as compared to divorced women. Out of 948 hrHPV-positive clients, 786 (82.9%) had a follow up VIA screening, of which 15.5% (122) were found to be VIA positive. A history of STI was significantly associated with VIA positivity (AOR = 1.69, 95% CI 1.12, 2.54). CONCLUSION: The prevalence of hrHPV in WWH was high as compared to other studies done in Ethiopia, particularly that of HPV 16 and "other hrHPV". Prevalence of cervical lesion based on VIA was higher as compared to other studies that did not initially screen for hrHPV infection. This underlines the need to offer screening services to WWH and further characterize the other hrHPV. Screening for cervical lesions is of particular importance in women who report a history of STIs.