Prevalence and distribution of high-risk human papillomavirus genotypes among women living with HIV in Nigeria

Women living with HIV (WLHIV) are at significantly higher risk of persistent high-risk human papillomavirus (hrHPV), and consequently, cervical cancer. However, large scale data on the epidemiology of hrHPV genotypes among WLHIV are limited in Nigeria. The study aimed to determine the prevalence and distribution of hrHPV among WLHIV in Nigeria. We conducted a cross-sectional study among 1327 WLHIV aged 25−60 years receiving HIV care from six selected Nigeria Implementation Science Alliance–Model Innovation and Research Centers (NISA-MIRCs) across Nigeria. Cervical swabs were obtained, and HPV DNA genotype was determined using the Hybribio Genoarray assay that detects 37 HPV genotypes including 14 high-risk HPVs. Sociodemographic and clinical data were collected using interviewer-administered structured questionnaire. Factors independently associated with hrHPV infection were identified using multivariable logistic regression. Statistical analysis was performed using R statistical software (version 4.4.1) with significance set at p < 0.05. Among the 1105 participants with analyzable samples, the overall HPV and hrHPV prevalence were 30.9% and 22.1%, respectively, with regional differences. Non-HPV 16 and 18 accounted for nearly two-thirds (67.6%) of hrHPV infections. The top five most often detected hrHPVs were HPV-58 (14.2%), HPV-16 (12.7%), HPV-52 (12.4%), HPV-31 (10.6%), and HPV-18 (10.3%). In a multivariate analysis, ART usage for one year or less was associated with hrHPV infection (aOR = 8.2, 95% CI 4.3–16.0). This multi-site study showed a significant and genotype-diverse burden of hrHPV among HIV-positive women in Nigeria, with most infections caused by non-HPV16/18 variants. These findings emphasize the need for increased integration of cervical cancer screening within HIV care and support the call for HPV vaccines with broader genotype coverage beyond HPV 16 and 18 to address the prevailing genotype distribution in this population.