Abstract
BACKGROUND: Chronic infection by human papillomavirus (HPV) is necessary for the development of almost all cervical cancers. The study assessed the prevalence of vaginal and cervical HPV infections in women living with HIV (WLWH) in Rwanda and assessed the performance of vaginal HPV screening to detect cervical HPV infections. METHODS: HIV-positive women (N = 413) attending the HIV clinic at the University Teaching Hospital of Kigali, Kigali, Rwanda, were interviewed and vaginal and cervical swab samples for HPV testing and a pap smear sample were taken. RT-PCR was performed to detect twelve high-risk (HR)-HPVs (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 and two low-risk (LR)-HPVs (HPV6 and 11) and conventional cytology was performed. RESULTS: Vaginal HR-HPV/LR-HPV infections occurred in 39.2%/4.4% of women, while cervical HR-HPV/LR-HPV infections occurred in 38.3%/4.8% of women. HPV58 (14.3%/13.5%), HPV52 (12.5%/12.4%), HPV51 (12.9%/11.7%) and HPV16 (9.9%/11.3%) were the most prevalent HPV infections in the vagina/cervix and one third of HPV-positive women were infected with more than one HPV type. Normal cytology was less common in women with cervical HR-HPV infections compared to HPV-negative women (75.8% and 87.9%, respectively, p = 0.032). The type-specific HPV agreement for all HPV types between vaginal and cervical samples was 98.4% (kappa: 0.82 ± 0.02; p < 0.0001). Screening for vaginal HPVs gave a sensitivity of 83.5% (confidence interval: 78.4-87.7), specificity of 99.1% (98.8-99.3%), positive predictive value of 81.6% (77.0-85.5%) and negative predictive value of 99.2% (99.0-99.4%) for cervical HPV infections. CONCLUSIONS: HR-HPVs are common in WLWH in Rwanda. Vaginal HPV testing may potentially be used to simplify cervical cancer screening in the future in Rwanda.