Molecular epidemiology of human papillomavirus genotypes among HIV-positive and HIV-negative women with cervical cancer in Nigeria

Background The prevalence of invasive cervical cancer (ICC) is high in Nigeria, with over 12,000 new cases and 8,000 deaths annually. Differences in diagnostic methods for human papillomavirus (HPV) genotypes have generated varied prevalence rates across populations. Methods We examined the prevalence and distribution of HPV genotypes among HIV-negative women with ICC, HIV-positive women with ICC, and HIV-positive women without ICC. We utilized baseline data and DNA samples from cervical tissue obtained from a prospective cohort study between March 2018 and September 2022. High-throughput next-generation amplicon sequencing of the HPV L-1 gene was used to identify and classify the HPV genotypes. Modified Poisson regression models estimated associations between HIV and HPV status, adjusting for other variables of interest. Results Among 286 women tested for HPV, 48.9% were HIV-negative with ICC, 17.2% were HIV-positive with ICC, and 33.9% were HIV-positive without ICC. The prevalence of high-risk HPV (HR-HPV) was 77.6% among HIV-positive women with ICC, whereas it was 60.0% among HIV-negative women with ICC (p < 0.001). HIV-positive women more frequently had multiple HPV genotypes (8.2% versus 1.4% among HIV-negative women with ICC and 2.1% among HIV-negative women without ICC) (p < 0.001). HPV16 or HPV18 accounted for 29.4% of all HPV cases. The most frequently detected HR-HPV genotypes included HPV16 (20.6%), HPV18 (8.7%), HPV45 (4.2%), and HPV35 (2.8%). In multivariable models adjusted for age, BMI, parity, and study site, HIV-positive women had an increased risk of HR-HPV (aPRR = 1.46, 95% CI: 1.17, 1.82) and any HPV infection (aPRR = 2.29, 95% CI: 1.83, 2.74) compared to HIV-negative women. Conclusion Our NGS approach to HPV typing in Nigerian women, including those with cervical cancer and HIV, revealed the presence of HPV types not covered by the Gardasil-4 vaccine. This highlights the need for broader coverage of vaccines to protect against most HR-HPV types, irrespective of HIV status.