1 Epidemiology of High-risk Human Papillomavirus and Cervical Lesions in African women living with HIV/AIDS: Effect of Anti- Retroviral Therapy Running title: HPV and CIN2+ in African women living with HIV-1 Authors: Helen A. KELLY 1 , Bernard SAWADOGO 2 , Admire CHIKANDIWA 3 , Michel SEGONDY 4 , Clare GILHAM 1 , Olga LOMPO 2 , Tanvier OMAR 5 , Marie-Noelle DIDELOT 4 , Nicolas NAGOT 4 , Nicolas MEDA 2 , Helen A. WEISS 1,6 , Sinead DELANY-MORETLWE 3 and Philippe MAYAUD 1,3 for the HARP Study Group* Affiliations: 1. London School of Hygiene and Tropical Medicine, London, UK 2. Centre de Recherche Internationale en Santé, University of Ouagadougou, Burkina Faso 3. RHI, University of the Witwatersrand, Johannesburg, South Africa 4. INSERM U1058 and University Hospital (CHRU), Montpellier, France 5. National Health Laboratory Services, Johannesburg, South Africa 6. MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK Corresponding author:
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1
Epidemiology of High-risk Human Papillomavirus and Cervical
Lesions in African women living with HIV/AIDS: Effect of Anti-
Retroviral Therapy
Running title: HPV and CIN2+ in African women living with HIV-1
Authors:
Helen A. KELLY1, Bernard SAWADOGO2, Admire CHIKANDIWA3, Michel SEGONDY4,
Clare GILHAM1, Olga LOMPO2, Tanvier OMAR5, Marie-Noelle DIDELOT4, Nicolas
NAGOT4, Nicolas MEDA2, Helen A. WEISS1,6, Sinead DELANY-MORETLWE3 and
Philippe MAYAUD1,3 for the HARP Study Group*
Affiliations:
1. London School of Hygiene and Tropical Medicine, London, UK
2. Centre de Recherche Internationale en Santé, University of Ouagadougou,
Burkina Faso
3. RHI, University of the Witwatersrand, Johannesburg, South Africa
4. INSERM U1058 and University Hospital (CHRU), Montpellier, France
5. National Health Laboratory Services, Johannesburg, South Africa
6. MRC Tropical Epidemiology Group, London School of Hygiene and Tropical
Medicine, London, UK
Corresponding author:
Helen Kelly, Clinical Research Department, Faculty of Infectious and Tropical
Diseases, London School of Hygiene and Tropical Medicine, Keppel Street,
NM, SD; Performed the lab testing: JN, OL, TO, MND; Analysed the data: HK, HW,
CG; Wrote the first draft of the manuscript: HK, HW, PM; Contributed to the
writing of the manuscript: HK, HW, PM, MS, NN, SD; Criteria for authorship read
and met: HK, BS, AC, MS, JN, OL, TO, CG, MND, NN, NM, SD, HW, PM; Agree with
manuscript results and conclusions: all.
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Figure 1 Study flowchart
*Type swap is defined as clearance of one genotype and acquisition of a different genotype
Adjusted Prevalence Ratio (aPR): 1Model1: In BF, associations with HR-HPV were adjusted for alcohol use, marital status, age at first pregnancy and cervicitis; and in SA, associations with HR-HPV were adjusted for age, smoking, injectable contraception, condom use, vaginal cleansing, genital warts, bacterial vaginosis (BV), infection with Chlamydia trachomatis and Trichomonas vaginalis; 2Model 2: same as Model 1 with additional adjustment for CD4+ count ; Adjusted Odds Ratio (aOR): 3In BF, associations with CIN2+ were adjusted for age, BV and cervical ectopy; and in SA, associations with CIN2+ were adjusted for age at first pregnancy, injectable contraception and number of lifetime sex partners; 4Model 2: same as Model 1 with additional adjustment for CD4+ ; §CD4+ count was unavailable for 1 participant on ART in BF;†HIV-1 PVL data was unavailable for 29 ART users in BF and 4 in SA; ‡Data on self-reported adherence was unavailable for 24 participants in BF and 4 in SA
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Table 4. Effect of HIV related factors on HR-HPV persistence, using infections as unit of measure Burkina Faso1
Yes 20 9 (45.0) 1.00 42 7 (16.7) 1.00Adjusted Odds Ratio (aOR) using generalised estimating equation: 1In BF, associations with HR-HPV were adjusted for alcohol use , marital status, age at first pregnancy and cervicitis ; 2In SA, associations with HR-HPV were adjusted for age, smoking, injectable contraception, condom use, vaginal cleansing, genital warts, bacterial vaginosis, Chlamydia trachomatis and Trichomonas vaginalis; §ART use was defined as being on ART at both baseline and endline; *Baseline HIV-1 PVL data was unavailable for 12 participants in BF (representing 17 infections) and 1 in SA (representing 1 infection); †Baseline CD4+ among participants who were ART-naïve at baseline ‡ ART-naïve participants were defined as being ART-naive at both baseline and endline.