Transcript Slide 1

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Human Papillomavirus Infection and Genotype
Distribution in Relation to Cervical Cytology
Abnormalities and HIV-1 Infection at Tikur Anbessa
Teaching Hospital, AA, Ethiopia
M. Derese*, Y.G/hiwot, S.Maayan,S.G/Sillasie,D.Wolday, B. Tsegaye, W.Ergete
ICASA 2011,AA Ethiopia, Dec.5,2011
Muluken Derese BSc, MSc
Background
 Data is not yet available on the HPV burden in the general population of
Ethiopia.
 Studies in Ethiopia from cervical biopsies on cervical cancer suspects
showed 67.1% in Jimma (Bekele et al., 2010) and 92.6% in Gonder
(Fanta. 2005)
 In all studies HPV 16 was the most frequent one followed by HPV 18.
 In Ethiopia ~ 7619 women are diagnosed with cervical cancer and 6081 die
annually (Parkin et al., 2005).
 No data is available on HIV/HPV co-infection and its association with
cervical cytology abnormality
Objectives
1.
To determine the prevalence of Human Papilloma Virus
infection in the study population.
2. To identify the prevalent HPV genotype in the study
population.
3. To determine the association of HIV -1 infection and CD4
count level on HPV prevalence and cervical cytology
abnormality.
4. Identify risk factors that are associated with Human Papilloma
Virus infection and cervical cytology abnormality.
Methodology
 Cross sectional
 From January 2009 __ Dec. 2010
 Consecutive , Consenting and eligible women:
 Attending Gynecology and Obstetrics OPD - 245
 From HIV clinic (ART naïve women) – 115
 HIV test and CD4 count were done
 Cervical swab was taken for Pap smear and Nested PCR
 MY09/MY11 and GP5+/GP6+ primers
 Genotyping was done using direct sequencing which was
compared against stored database in gene bank using the BLAST
 At Hadassah University Hospital, Jerusalem (Israel)
Methodology
Flow Chart summarizing study methodology
Cross sectional study
Women attending Gyn/Obs out patient Clinic and HIV clinic
Eligible and consenting
Questionnaire (pre-HIV counseling)
Blood sample
HIV Test
CD4 count
Two cervical swabs
Pap smear
HPV Detection
Genotyping
Result
HPV Prevalence in all study participants:
232/360
(64.4%)
 HIV- Negative women =
 HIV- Positive women =
 HR HPV = (181/232)
 Most prevalent HR HPVs
HPV 16 =46 %
HPV 35 =8.2%
HPV 56=7.1%
HPV 45= 6.6%
HPV 18 =6.1%
78%
153/245 (62.4 %)
79/115
(68.7%)
Prevalence of High Risk HPV Genotypes
50%
45%
46%
40%
Value in Percent
35%
30%
25%
20%
15%
10%
5%
0%
6% 4%
8%
1%
3%
7%
7%
1% 2%
4%
2% 1% 1%
4%
2% 1%
HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV HPV
16 18 31 33 35 39 45 51 52 56 58 59 66 68 70 73 82
HR HPV Genotypes
Result Cont…
Cytology Findings
 Abnormal cervical cytology finding
26.1% (94/360)
 HIV positive women = 16.5% (19/115 )
 Mean age = 34
 Mean CD4 count =205.9 cells/μl
 HIV negative women= 30.6% (75/245)
 Mean age =52
Result Cont…
Proportion of Abnormal Cervical Cytology Stages
SCC
21%
CIN I
19%
CIN I
CIN II
CIN II
15%
CIN III
45%
CIN III
SCC
Result Cont…
 HR HPV infection in women with normal cervical cytology
finding was

68.1% (94/138)
 HR HPV infection in women with abnormal cervical cytology
finding:

93.6% (88/94)
 Most frequently detected HR HPVs in abnormal cervical
cytology finding
 HPV 16= 62.7%
 HPV 45= 7.4%
 HPV 35= 5.3%
 HPV 18 = 4.5%
Result Cont…
Risk factors associated with abnormal cervical cytology
 HPV infection
P= 0.000 (AOR 2.3 95% CI 1.4, 5.3 )



Age (P=0.000)
35-50 : AOR 3.1 (95% CI= 1.5, 6.3)
> 50 : AOR 8.8 (95% CI= 4.1, 19.1)
Living out of Addis Ababa
AOR 2.3 (95% CI 1.1, 4.8)
Low CD4 count
54% of women with CD4 count less than 50 cells/µl had abnormal cervical
cytology finding (P=0.006).
Conclusion
 HPV prevalence was almost similar In both HIV positive and
HIV negative women.
 In HIV negative women prevalence of abnormal cervical
cytology result was high compared to HIV positive women.
 Among HIV positive women abnormal cervical cytology was
frequent at early age .
 where most low grade lesions were detected in women aged <30 years.
 SCC was noticed only in HIV negative women
 which was associated with the older age of HIV negative women.
Recommendations
 Population-based methodically designed study is needed:
 To detect the burden of HR HPV infection in the general population
 Ethiopia needs to develop a new and expanded cervical
cancer prevention programs to all strata of the population
which includes:
 Screening of women aged above 30 yrs old
 Implementation of the available vaccine for those who are not
exposed for the HPV 16,18,6 or 11.
 Increasing awareness on cervical cancer prevention methods.
Acknowledgments
 The Department of Microbiology, Parasitology and Immunology, Addis
Ababa University.
 Hadassah University Hospital , Jerusalem ,Israel.
 Dr. Yirgue Gebrehiwot and Dr. Solomon G/sellassie
 Prof. Shlomo Maayan, Prof. Dana Wolf ,Ms Orit Caplan and Mr Leonid
Levinson
 Dr. Dawit Wolday, Dr. Bekure Tsegaye, Dr. Wondwossen Ergete.
 Ato Tilahun Nigatu