RESEARCH ARTICLE
High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZuluNatal, South Africa Sumayyah Ebrahim1☯*, Xolani K. Mndende2☯, Ayesha B. M. Kharsany3‡, Zizipho Z. A. Mbulawa2,4, Vivek Naranbhai3,5, Janet Frohlich3, Lise Werner3‡, Natasha Samsunder3, Quarraisha Abdool Karim3,6, Anna-Lise Williamson2,7 1 Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, 2 Division of Medical Virology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, 3 Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, 4 Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa, 5 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, 6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America, 7 National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa OPEN ACCESS Citation: Ebrahim S, Mndende XK, Kharsany ABM, Mbulawa ZZA, Naranbhai V, Frohlich J, et al. (2016) High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu-Natal, South Africa. PLoS ONE 11(1): e0146603. doi:10.1371/journal.pone.0146603 Editor: Craig Meyers, Penn State University School of Medicine, UNITED STATES Received: September 9, 2015 Accepted: December 18, 2015 Published: January 19, 2016 Copyright: © 2016 Ebrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Sumayyah Ebrahim was supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP) through the Fogarty International Center, National Institutes of Health (grant# 5 D43 TW000231-18). Some of this work is based upon research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation. Funding for the HPV laboratory work was also
☯ These authors contributed equally to this work. ‡ These authors also contributed equally to this work. * [email protected]
Abstract Objectives HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women 30 years of age in KwaZulu-Natal (KZN), South Africa.
Methods Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV.
Results Median age of participants was 21 years [interquartile range (IQR):18–23]. The overall prevalence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3% and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22–9.60; p = 0.019), was significantly associated with HPV infection and high-risk HPV genotype infection.
PLOS ONE | DOI:10.1371/journal.pone.0146603 January 19, 2016
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HPV among Women
provided by the National Health Laboratory Service Research Trust and student (XKM) bursary by Poliomyelitis Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.
Conclusion The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPVrelated morbidity.
Introduction Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses [1, 2]. More than 100 types of HPV have been identified, and of these about 40 types are known to infect the anogenital tract. Eighteen types; in particular, HPV 16 and HPV 18, described as high-risk/oncogenic types, are associated with the development of cervical cancer. The lowrisk/non-oncogenic HPV types (mainly types 6 and 11), result in genital warts [2]. The majority of cervical HPV infections are cleared or suppressed by cell-mediated immunity within 1–2 years of exposure [3]. Persistent cervical HPV infection with high- risk/oncogenic types is associated with an increased risk of cervical intraepithelial neoplasia (CIN) and eventual malignancy [3]. Additionally, HPV is associated with non-cervical cancers such as vulval, vaginal, anal and oropharyngeal cancers [4]. Globally, the prevalence of HPV among women with normal cytology is around 12%, whilst in Sub-Saharan Africa the rates are much higher at around 24%, ranging from 17.4% to 33.6% [5]. Young women
High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZuluNatal, South Africa Sumayyah Ebrahim1☯*, Xolani K. Mndende2☯, Ayesha B. M. Kharsany3‡, Zizipho Z. A. Mbulawa2,4, Vivek Naranbhai3,5, Janet Frohlich3, Lise Werner3‡, Natasha Samsunder3, Quarraisha Abdool Karim3,6, Anna-Lise Williamson2,7 1 Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, 2 Division of Medical Virology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa, 3 Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, 4 Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa, 5 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, 6 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America, 7 National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa OPEN ACCESS Citation: Ebrahim S, Mndende XK, Kharsany ABM, Mbulawa ZZA, Naranbhai V, Frohlich J, et al. (2016) High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu-Natal, South Africa. PLoS ONE 11(1): e0146603. doi:10.1371/journal.pone.0146603 Editor: Craig Meyers, Penn State University School of Medicine, UNITED STATES Received: September 9, 2015 Accepted: December 18, 2015 Published: January 19, 2016 Copyright: © 2016 Ebrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Sumayyah Ebrahim was supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP) through the Fogarty International Center, National Institutes of Health (grant# 5 D43 TW000231-18). Some of this work is based upon research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation. Funding for the HPV laboratory work was also
☯ These authors contributed equally to this work. ‡ These authors also contributed equally to this work. * [email protected]
Abstract Objectives HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women 30 years of age in KwaZulu-Natal (KZN), South Africa.
Methods Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV.
Results Median age of participants was 21 years [interquartile range (IQR):18–23]. The overall prevalence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3% and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22–9.60; p = 0.019), was significantly associated with HPV infection and high-risk HPV genotype infection.
PLOS ONE | DOI:10.1371/journal.pone.0146603 January 19, 2016
1 / 10
HPV among Women
provided by the National Health Laboratory Service Research Trust and student (XKM) bursary by Poliomyelitis Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.
Conclusion The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPVrelated morbidity.
Introduction Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses [1, 2]. More than 100 types of HPV have been identified, and of these about 40 types are known to infect the anogenital tract. Eighteen types; in particular, HPV 16 and HPV 18, described as high-risk/oncogenic types, are associated with the development of cervical cancer. The lowrisk/non-oncogenic HPV types (mainly types 6 and 11), result in genital warts [2]. The majority of cervical HPV infections are cleared or suppressed by cell-mediated immunity within 1–2 years of exposure [3]. Persistent cervical HPV infection with high- risk/oncogenic types is associated with an increased risk of cervical intraepithelial neoplasia (CIN) and eventual malignancy [3]. Additionally, HPV is associated with non-cervical cancers such as vulval, vaginal, anal and oropharyngeal cancers [4]. Globally, the prevalence of HPV among women with normal cytology is around 12%, whilst in Sub-Saharan Africa the rates are much higher at around 24%, ranging from 17.4% to 33.6% [5]. Young women
