Prevalence and genotype specific concordance of oro-genital and anal human papillomavirus infections among sexually active Nigerian women

Changes in Oral Papilloma Virus Infections Over Six Months in People Living with HIV

There is a paucity of data on changes in oral papilloma virus (PV) infection in people living with HIV (PLHIV) especially in low resource settings. The objective of this study was to determine the changes in oral PV infections in PLHIV from a low resource setting over a six-month follow-up period. This was a cohort study in which data was derived from a sub-sample of a parent study that examined oral human papilloma viruses, microbiota, and cancer in PLWHIV. This as a six-month follow up and a 2 mls saliva sample was collected from 541 participants on both visits. The saliva sample was used for DNA extraction, PV screening and typing using PCR methods. The DNA was subjected to Nanopore PV sequencing and subsequently analyzed using the phyloseq object, followed by a series of comparisons using the Phyloseq and Vegan packages in R to generate the alpha and beta diversity indices of the sequencing data from the sampled participants PV OTUs at the two visits. We found that 60% of participants had no detectable PVs at six-month follow-up, with a significant clearance rate of 84.47%. Oncogenic PVs were less likely to be detected as new infections compared to non-oncogenic PVs (Rate Ratio (RR) 0.42, 95% CI 0.31 to 0.56, P < 0.01). Oncogenic PV types were more likely cleared than non-oncogenic strains (RR 1.16, 95% CI 1.03 to 1.31, P = 0.02), but persistence rates did not significantly differ. This study highlights important trends in the natural course of oral PV infections, demonstrating that while most infections clear over time, there are distinct differences in the behavior of oncogenic versus non-oncogenic strains. These findings have important implications for the understanding of PV epidemiology and may guide future preventive and therapeutic strategies, particularly in the context of Human PV-related cancer prevention.

Prevalence of Oral Human Papilloma virus infection in an East African HIV/AIDS cohort: A cross-sectional study

Background

Little is known about the prevalence of Oral Human Papilloma Virus (OHPV) in people living with HIV (PLWHIV) in the East African region. The objective of this study was to document the prevalence and types OHPV infection in a large cohort of PLWHIV attending an urban HIV clinic in Eastern Africa.

Methods

This was a cross-sectional study among 1,715 participants of the Makerere University Joint AIDS Program clinic, located in Kampala, Uganda, in East Africa. A salivary sample was collected from which DNA was extracted and subjected to a Polymerase Chain Reaction (PCR) based typing. Data analysis was carried out among participants with complete data (n = 1,243) and relied on descriptive statistics (frequencies, percentages), bivariate testing and multivariate regression modeling, using a conventional p < 0.05 statistical significance threshold.

Results

Participants had a mean age of 45 (SD = 10) years, most (69%) were female, and 67% were HPV positive. There was no association between participants' age or gender and the likelihood of them being diagnosed with HPV infection in this study. HPV type 45 was the most frequently (16%) identified HPV, while HPV type 18 (5%) and HPV type 16 (2.3%) were less frequently identified. Most of the HPV positive samples had more than one HPV type detected.

Conclusion

This study highlights the high prevalence of OHPV among PLWHIV, with HPV type 45 being the most frequently detected type, and smaller frequencies of vaccine targeted HPV 16 and HPV 18. Our findings highlight the need for continued surveillance and typing of circulating OHPV strains, particularly among PLWHIV, to inform evidence-based preventive strategies.

Assessment of Relative Contributions of Lifestyle, Behavioral and Biological Risk Factors for Cervical Human Papillomavirus Infections in Female Sex Workers

This study aimed to identify and quantify the relative and collective contributions of lifestyle, behavioral, and biological risk factors to cervical HPV infections among female sex workers (FSWs) in Ibadan, Nigeria. This cross-sectional study was part of the Sexual Behavior and HPV Infections in Nigerians in Ibadan project and involved 182 FSWs for whom complete data on HPV genotypes were available. Quantile-based g-computation was employed to assess the relative and collective contributions of risk factors to any cervical HPV/hrHPV infections and multiple cervical HPV/hrHPV. The collective contribution of all selected risk factors to multiple high-risk cervical HPV was 2.47 (95% CI: 0.97-3.23). The number of other anatomic sites with HPV infections showed the highest positive relative contribution to multiple cervical HPV/hrHPV. Alcohol consumption and the total number of sexual partners contributed to high-risk cervical HPV and multiple cervical HPV/hrHPV, while age at first vaginal sex had a negative relative contribution. This study highlights the significant contribution of HPV infections in multiple anatomic sites as a risk to the acquisition of cervical HPV in FSWs. Routine screening protocols should be enhanced to include multiple anatomic sites, and targeted educational programs are recommended to address the specific risks faced by FSWs.

Systematic review and meta-analysis of the prevalence of oral cancer in Nigeria

INTRODUCTION

Oral cancer is ranked among the ten most common cancers in the world and is a growing public health concern in Nigeria. However, the extent of the burden of oral cancer in Nigeria is poorly understood. A better understanding of the prevalence of oral cancer will inform the development and implementation of efficient and effective oral cancer prevention and management strategies. This systematic review and meta-analysis aimed to estimate the prevalence of oral cancer in Nigeria to guide relevant oral health interventions and policies.

METHODS

We searched PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science for studies published from 1990 until August 15, 2023. We included cohort, cross-sectional, case-control, descriptive, and interventional studies that reported prevalence data for oral cancer in Nigeria. The primary outcome was the pooled prevalence of oral cancer. Meta-analysis was performed using the random effect model. The Higgins inconsistency index -I2 index was used to evaluate heterogeneity. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

In total, 3025 articles were screened, and data from 7 studies with a total sample size of 9188 (1702 oral cancer cases) were included in the meta-analysis. Participants age ranged from 0 to 100 years. Oral cancer prevalence varied across the studies, ranging from 7.5% to 41%. The pooled prevalence of oral cancer in Nigeria was 20% (95% confidence interval, CI:0.11-0.28, I2 = 99%, P < 0.0001). An estimate of the total variation between studies revealed substantial heterogeneity (I2 = 99%). The prevalence rate differed between gender populations, with more predilection to males (11%) than females (7%).

CONCLUSIONS

The current analysis indicates an overall pooled oral cancer prevalence of 20% in Nigeria. The high burden of oral cancer in Nigeria highlights a need for public health interventions and policies to promote the prevention and early detection of oral cancer. The analysis also shows a higher prevalence of oral cancer among men. Population-based studies are necessary to better understand individual differences in oral cancer.

Nanopore sequencing of non-oncogenic oral Papillomaviruses from people living with HIV

Objective

To explore the diversity of non-oncogenic papillomaviruses in saliva samples from people living with HIV using nanopore amplicon-based sequencing for detection and typing.

Methods

This was a secondary analysis of data from the nanopore sequencing of amplicons obtained from polymerase chain reaction detection of papillomaviruses from 127 samples of people living with HIV. The sequencing data was cleaned and analyzed using a series of bash, Python and R scripts to produce output based on comparisons with the PAVE reference database for all known non-oncogenic papillomaviruses.

Results

A total of 171,194 reads corresponding to 201 known papillomavirus types were obtained from the data. Most of these reads (69%), belonged to the human non-oncogenic papillomavirus types. The most abundant nonhuman and non-oncogenic PV, Trichechus manatus latirostris papillomavirus 4 in 99% of the samples. There were nine other less abundant non-oncogenic papillomaviruses that were found in 95% or more of the samples as mixed infections.

Conclusions

This study demonstrates that there are many non-oncogenic PV infections in samples from PLHIV, most of which are mixed infections from this setting. It is important to note that the non-human non-oncogenic PVs, as a potential one health concern, were highly prevalent in this population.

Prevalence and concordance of penile, anal, and oral human papillomavirus infections among sexually active heterosexual men in Ibadan, Nigeria

BACKGROUND

The data on epidemiology of Human papillomavirus (HPV) infections in men are scarce relative to women generally, particularly among men engaging in heterosexual relationships. This study investigated the prevalence and risk factors for penile, anal, and oral HPV in men in two communities in Ibadan, Nigeria.

METHODS

This was a cross-sectional survey involving a face-to-face interview, a clinical examination, and sample collection from participants. HPV genotyping was performed with Anyplex II 28 HPV assay. The prevalences and factors associated with HPV infections using multivariable models and concordance between sites.

RESULTS

Of 316 men, the proportion of any HPV infection in the penile, anal, and oral sites was 40.5%, 9.7%, and 7.8%, respectively. The proportion of any high-risk HPV, low-risk HPV, and multiple HPV infections was highest in the penis followed by the anal and oral sites. Only 5/316 (1.6%) men had concordant HPV in all three sites, with the highest concordance in penile-anal sites relative to penile-oral and anal-oral sites. The odds of penile HPV were higher in men aged 25 years and above. Having penile HPV was associated with higher odds of detecting anal HPV and vice versa. Oral HPV was less likely in men not living with their sexual partners.

CONCLUSION

Penile HPV is the most common infection followed by anal HPV and oral HPV infections among heterosexual Nigerian men. Concordant HPV infections was highest in penile-anal sites. Nigerian men, as in other settings, are a reservoir of HPV and it is important to conduct more robust studies to appreciate their role in HPV transmission, epidemiology, and prevention.

Prevalence and risk factors for high-risk human papillomavirus infection among women from three southern geopolitical zones of Nigeria

Introduction

Human Papillomavirus (HPV) infection is a risk factor for cervical cancer, the fourth most common cancer among women globally. Its burden is the highest in sub-Saharan Africa, with over 90% mortality. Interventions may fail without evidence-based data on stratified prevalence and risk factors among most at-risk women across Nigeria.

Methods

A cross-sectional comparative study, with participants recruited from the Nigerian Institute of Medical Research's Clinics, NGO outreaches, a cancer screening centre and a university teaching hospital. Questionnaires were self-administered. Trained medics performed sampling at healthcare facilities, and self-sampling was used at outreaches.

Results

Nine hundred eighty-five study participants were recruited. About 37% and 27% of the women knew about HPV and its vaccines, respectively, but only 6% confirmed vaccination with HPV vaccines. HPV prevalence was highest among women with unknown marital status (35.9%), single women (33.8%), widowed/divorced/separated women (30.3%), and married/cohabiting women (19.6%). HPV infection was significantly higher among women who take alcohol (odds=1.7 [95% CI: 1.2-2.4]) and women who smoke (odds=2.6 [95% CI: 1.4 - 4.6]. HPV strains detected included HPV16 (1.3%), HPV18 (1.5%), Low Risk (0.2%) and Other High-Risk groups (19.7%).

Conclusion

The inverse relationship between prevalence and education suggests interventions improving awareness and prevention would be impactful. Such interventions could also target HIV-positive women, women presenting with sexually-transmitted infections, who smoke and frequently drink alcohol.

Diversity of Anal HPV and Non-HPV Sexually Transmitted Infections and Concordance with Genital Infections in HIV-Infected and HIV-Uninfected Women in the Tapajós Region, Amazon, Brazil

The aim of this study was to classify the diversity of anal HPV and non-HPV sexually transmitted infections (STIs) and compare the concordance between anal and genital infections in HIV-infected and uninfected women living in the Tapajós region, Amazon, Brazil. A cross-sectional study was performed with 112 HIV-uninfected and 41 HIV-infected nonindigenous women. Anal and cervical scrapings were collected and analyzed for HPV, Chlamydia trachomatis (CT), Neisseria gonorrheae (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), and Human alphaherpesvirus 2 (HSV-2). The Kappa test evaluated the concordance between anal and genital infections. The overall prevalence of anal HPV infection was 31.3% in HIV-uninfected and 97.6% in HIV-infected women. The most frequent anal high-risk HPV (hrHPV) types were HPV18 and HPV16 in HIV-uninfected women and HPV51, HPV59, HPV31, and HPV58 in HIV-infected women. Anal HPV75 Betapapillomavirus was also identified. Anal non-HPV STIs were identified in 13.0% of all participants. The concordance analysis was fair for CT, MG, and HSV-2, almost perfect agreement for NG, moderate for HPV, and variable for the most frequent anal hrHPV types. Thus, a high prevalence of anal HPV infection with moderate and fair concordance between anal and genital HPV and non-HPV STIs was observed in our study.

Prevalence of Human Papillomavirus in Different Mucous Membranes in HIV Concordant Couples in Rwanda

BACKGROUND

The prevalence of human papillomavirus (HPV) infections in other anatomical sites besides the uterine cervix is unknown in East Africa. Here, we assessed the prevalence and concordance of HPVs in different anatomical sites in HIV concordant couples in Rwanda.

METHODS

Fifty HIV-positive concordant male-female couples at the HIV clinic at the University Teaching Hospital of Kigali in Rwanda were interviewed, swabbed from the oral cavity (OC), oropharynx (OP), anal canal (AC), vagina (V), uterine cervix (UC) and penis. A pap smear test and a self-collected vaginal swab (Vself) were taken. Twelve high-risk (HR)-HPVs were analyzed.

RESULTS

HR-HPVs occurred in 10%/12% in OC, 10%/0% in OP and 2%/24% in AC (p = 0.002) in men and women, respectively. HR-HPVs occurred in 24% of UC, 32% of Vself, 30% of V and 24% of P samples. Only 22.2% of all HR-HPV infections were shared by both partners (κ -0.34 ± 0.11; p = 0.004). The type-specific HR-HPV concordance was significant between male to female OC-OC (κ 0.56 ± 0.17), V-VSelf (κ 0.70 ± 0.10), UC-V (κ 0.54 ± 0.13), UC-Vself (κ 0.51 ± 0.13) and UC-female AC (κ 0.42 ± 0.15).

CONCLUSIONS

HPV infections are prevalent in HIV-positive couples in Rwanda but concordance within couples is low. Vaginal self-sampling for HPV is representative of cervical HPV status.

Molecular characterization and risk factors of oral high-risk human papillomavirus among females in Punjab, Pakistan

BACKGROUND

The development of oral and oropharyngeal cancers is associated with human papillomavirus (HPV) infection. However, debate exists about the prevalence of high-risk oral HPV (HR-HPV) and its associated risk factors. This study evaluated the distribution of genotypes and associated risk factors of oral HR-HPV infection in the normal oral mucosa of the Pakistani female population with general gynecological problems.

METHODS

A total of 200 females from a regional gynecological hospital in Pakistan were included in this cross-sectional study. A self-administered questionnaire was carried out, followed by the study participants' oral and dental examinations. Whole saliva was collected by a drooling method. The viral DNA extraction and oral HR-HPV genotyping were detected via real-time polymerase chain reaction.

RESULTS

Among the 200 females (mean age, 37.76 years), 22 females (11%) were positive for oral HR-HPV DNA. Single oral HR-HPV infection was seen in 8%, whereas co-infection was observed in 3% with HPV16 and HPV18 most common genotypes. Comparison of the risk factors like oral sex history odds ratio (OR 8.21, 95% confidence interval [CI] 1.85-28.16; p < 0.005), and open-mouth kissing (OR, 5.17; 95% CI 1.48-27.41; p = 0.005) with oral HR-HPV infection was found to be significantly associated.

CONCLUSION

In Pakistan, oral HR-HPV-positive infection is not uncommon; HPV16 and HPV18 are the most frequent genotypes. Furthermore, this study also provides data that oral HR-HPV positive infection was significantly associated with sexual behaviors. Therefore, preventive health efforts, like health education and vaccination, should be practiced.

Oral, genital and anal human papillomavirus infections among female sex workers in Ibadan, Nigeria

BACKGROUND

There are limited data on the epidemiology of HPV in different anatomical sites of female sex workers (FSW). We investigated the prevalence and concordance of cervical, vulval, oral and anal HPV among FSW in Ibadan, Nigeria.

METHODS

FSWs aged 18-45 years were enrolled in a cross-sectional survey. After interview and clinical examination, samples were collected from mouth, cervix, vulva and anus. HPV genotyping was done with Anyplex II 28HPV assay. Multivariable analyses were performed to explore associated risk factors and concordance of HPV infections across sites.

RESULTS

In total, 315 FSWs participated in the study with a mean age of 30-6.5 years. The prevalence of any HPV infection was 88% in the vulva, 84% in the cervix, 75% in the anus and 24% in the oral cavity. HPV 35 was the most prevalent and concordant high-risk type in the four sites. The risk factors for HPV infection by anatomic site varied.

CONCLUSION

This large study showed a high prevalence and concordance of HPV infections of cervical, vulval, oral and anal HPV among FSWs in Nigeria. The potential to acquire and transmit HPV is high in this population, and we highlighted the urgency to protect young women through HPV vaccination.