Prevalence and risk factors for human papillomavirus infection among women living with HIV in Sierra Leone: A cross-sectional study

BackgroundCervical cancer, a malignancy affecting the cervix, is the fourth most common cancer and cause of cancer-related mortality among women worldwide. This burden disproportionately affects low-resource regions, where approximately 90% of cases occur. HIV-positive women are at high risk of persistent Human Papillomavirus (HPV) infection and cervical cancer, but screening for this cancer is not yet integrated into HIV care in Sierra Leone. This study aimed to assess the prevalence and risk factors of high-risk HPV infection among women living with HIV (WLHIV) attending Connaught Hospital in Sierra Leone. Methods We conducted a cross-sectional study of women living with HIV aged 25-65 years attending the HIV clinic at Connaught Teaching Hospital in Freetown between September and December 2024. Endocervical swabs were collected for HPV DNA testing. Data was analyzed using R (v4.4.0). Logistic regression analysis was used to determine the independent risk factors for HPV positivity. Results A total of 191 WLHIV were enrolled. The mean age was 36.8 years; 44.5% were single, and 67% were employed. High-risk HPV DNA was detected in 60 (31.4%) (95% CI 25.3%-38.3%) participants, with 50% (30/60) having multiple serotypes. The most common genotype was HPV 52, followed by 16 and 51. Only 30% of HPV-positive women had genotypes 16 or 18, targeted by the bivalent vaccine. On multivariable analysis, former contraceptive use was independently associated with increased HPV positivity (aOR=4.86, 95% CI: 1.65-17.37, p = 0.0032). Conclusion The high prevalence of high-risk HPV infection and predominance of non 16/18 genotypes among WLHIV in Sierra Leone underscore the need to integrate HPV screening within HIV services and consider broader HPV vaccine coverage in Sierra Leone. Former contraceptive use is an independent predictor of HPV positivity, emphasizing the need for robust screening strategies in women using contraceptives.