# High-Risk Human Papillomavirus and Other Sexually Transmitted Infections Among Women Living With Human Immunodeficiency Virus in Jos, Nigeria

## TL;DR

This study found that women with HIV in Nigeria who are infected with high-risk HPV are more likely to have other sexually transmitted infections, which could increase their risk of cervical cancer.

## Contribution

The study establishes a significant association between high-risk HPV infection and co-infection with multiple STIs in HIV-positive women in Nigeria.

## Key findings

- High-risk HPV prevalence was 65.3% among HIV-positive women in the study.
- Approximately 40% of high-risk HPV-positive women were co-infected with at least one STI.
- Having multiple STIs was significantly associated with high-risk HPV infection.

## Abstract

Background

Women living with human immunodeficiency virus (WLWH) have a higher risk of acquiring human papillomavirus (HPV) and other sexually transmitted infections (STIs) due to their compromised immune systems. The presence of HPV, HIV, and other STIs has been implicated in cervical carcinogenesis. This study sought to understand and estimate the association between HPV infection and other STIs among HIV-positive women with and without cervical precancer.

Methodology

This study looked at women living with HIV who had been diagnosed with either low- or high-grade squamous intraepithelial lesions. This study was a part of the U54 cervical cancer project in Jos, Nigeria, from August 2019 to January 2022. Cervical swab samples were used for DNA extraction and genotyping using the HPV 28 Anyplex II (Seegene). To identify seven of the most common STIs, we used the Allplex™ STI Essential Assay (Seegene) and the Allplex™ Genital Ulcer Assay (Seegene) for seven ulcer-causing microbes.

Results

In total, 101 women were included in this study. The median age of the participants was 50 years (interquartile range = 43-57). The overall HPV prevalence was 65.3% (66/101). Among these, hrHPV infection occurred in 40.0% of the women in the age group of <40 years and 31.0% in the age group of ≥40 years. Approximately 40% of hrHPV-positive women were co-infected with at least one STI (p = 0.006). Having multiple STIs was associated with hrHPV infection (p = 0.019 for multiple essential STIs and p = 0.007 for multiple genital ulcers causing STIs). On univariate analysis, we found hrHPV to be associated at 95% confidence interval with any essential STI (p = 0.008), a single STI (p = 0.016), any genital ulcer microbe (p = 0.003), herpes simplex virus 1 (p = 0.043), Lymphogranuloma venereum (p = 0.017), and having a single ulcer-causing microbe (p = 0.004). In multivariate models adjusted for age, parity, HIV duration, and cervical neoplastic lesions, the odds ratio comparing hrHPV-positive to hrHPV-negative women was 10.4 (p < 0.001) for any genital ulcers causing microbial infections.

Conclusions

High-risk HPV infection was associated with the presence of other STIs in WLWH in Nigeria. Testing for STIs in women with hrHPV could have an impact on hrHPV-related carcinogenesis.