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Cervico-vaginal self-collection in HIV-infected and uninfected women from Tapajós region, Amazon, Brazil: High acceptability, hrHPV diversity and risk factors

Published:August 06, 2018DOI:https://doi.org/10.1016/j.ygyno.2018.08.004

      Highlights

      • High acceptability of cervico-vaginal self collection (CVSC) in women living in the Tapajós region, Amazon, Brazil
      • CVSC had significant agreement for any HPV and hrHPV detection when compared to cervical scraping (CS).
      • HIV-uninfected women without cervical lesions have high prevalence of any HPV, HPV16 and HPV18.
      • HIV-infected women with or without cervical lesions have high prevalence of any HPV, HPV16, HPV51 and HPV59.
      • HIV-infected women with lower CD4+ T-cell counts carried a significantly higher number of distinct hrHPV types.

      Abstract

      Objective

      We evaluated acceptability of cervico-vaginal self-collection (CVSC) and prevalence of human papillomavirus (HPV) in Human immunodeficiency virus (HIV)-infected and HIV-uninfected women living in the Tapajós region, Amazon, Brazil.

      Methods

      Cross-sectional study recruited 153 non-indigenous women (HIV-uninfected, n = 112 and HIV-infected, n = 41) who voluntarily sought assistance in health services. Peripheral blood for HIV screening and cervical scraping (CS) for HPV detection were collected. Women who accepted to perform CVSC received instructions and individual collection kits. Risk factors for high-risk HPV genotypes (hrHPV) were identified by uni- and multivariate analyses.

      Results

      The overall acceptability of CVSC was 87%. Only HIV-infected women had cytological abnormalities (12.2%). Prevalence of any HPV and hrHPV infection was 42.9% and 47.9% for HIV-uninfected and 97.6% and 77.5% for HIV-infected women, respectively. There was significant agreement in the detection of HPV (88%, 0.76, 95% confidence interval [CI], 0.65–0.87) and hrHPV (79.7%, 0.56, 95% CI, 0.41–0.71) between self-collected and clinician-collected samples. The most prevalent hrHPV types were HPV16 and HPV18 in HIV-uninfected and HPV16, HPV51 and HPV59 in HIV-infected women. HIV-infected women with hrHPV infection had multiple hrHPV infections (p = 0.005) and lower CD4 count (p = 0.018). Risk factors for hrHPV infection included being HIV-infected and having five or more sexual partners.

      Conclusions

      CVSC had high acceptability and high prevalence of hrHPV types in women living in the Tapajós region, Amazon, Brazil.

      Keywords

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