# Human Papillomavirus Genotype Landscape Across Cervical Cytology Grades and Impact of HIV Among Women of Eastern Cape Province, South Africa

## TL;DR

This study examines HPV genotype distribution across cervical cytology grades and HIV status in South African women, revealing high HPV prevalence and differences in genotype patterns.

## Contribution

The study provides new insights into HPV genotype distribution and its association with HIV status in cervical cancer prevention.

## Key findings

- HPV prevalence increases with abnormal cervical cytology, reaching 93.8% in ASC-US and 100% in LSIL.
- Non-HPV vaccine types dominate in HSIL and cervical cancer, highlighting gaps in current prevention strategies.
- HIV status influences HPV genotype patterns, though overall prevalence does not significantly increase with HIV co-infection.

## Abstract

Continuous surveillance of human papillomavirus (HPV) prevalence and genotype distribution in different cervical cytology grades is necessary for cervical cancer prevention and monitoring. This study investigated the distribution of HPV genotypes and associated factors, stratified by cervical cytology grades and human immunodeficiency (HIV) status, among women in the Eastern Cape Province, South Africa. A total of 540 women were recruited from a community health facility and a referral hospital in the OR Tambo District Municipality in Eastern Cape Province. HPV detection and genotyping in cervical cells were performed using the Seegene AllplexTM and AnyplexTM II HPV28 assays. HPV prevalence was 60.6% among women with normal cervical cytology, 93.8% among atypical squamous cells of undetermined significance (ASC-US), 100.0% among low-grade squamous intraepithelial lesions (LSILs), 95.2% among atypical squamous cells cannot exclude high-grade lesion (ASC-H), 93.7% among high-grade squamous intraepithelial lesions (HSILs), and 92.5% among women with cervical cancer. HPV types targeted by Gardasil-9® were detected in 36.0% of women with normal cervical cytology, 83.0% of those with HSIL, and 81.0% of those with cervical cancer. Among women with normal cervical cytology, HPV58, 35, and 68 were the most dominant types, HPV16, 33, and 35 in HSIL, and HPV16, 18, and 35 in cervical cancer. Differences were observed in the prevailing HPV genotype patterns when stratified by HIV infection status. This study highlights the high HPV prevalence, which further increased among women with abnormal cervical cytology. While HPV prevalence did not significantly increase with HIV co-infection, distinct differences were observed in the HPV genotype patterns when stratified by HIV status. The dominance of non-HPV vaccine types in HSIL and cervical cancer cases underscores a critical gap in current prevention strategies.