High-Risk HPV Persistence and Clearance Patterns Among Women in Ethiopia: A Longitudinal Study

Brhanu Teka,1,2 Adamu Addissie,2,3 Adane Mihret,1,4 Muluken Gizaw,2,3 Welelta Shiferaw,5 Zewditu Chanyalew,6 Andreas M Kaufmann,7 Eva Johanna Kantelhardt,2,8 Tamrat Abebe1,2 1Department of Microbiology, Immunology and Parasitology, School of Biomedicine and Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Global Health Working Group, Martin-Luther-University, Halle-Wittenberg, Germany; 3Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Armauer Hansen Research Institute, Addis Ababa, Ethiopia; 5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 6Department of Pathology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia; 7Department of Gynecology, Charité–Universitätsmedizin Berlin, Berlin, Germany; 8Institute for Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, GermanyCorrespondence: Brhanu Teka, Email [email protected]; [email protected]: High-risk human papillomavirus (hr-HPV) types are the primary cause of cervical and anogenital cancers. Understanding patterns of persistence, clearance, and re-infection is essential, as persistent infections contribute to precancerous and invasive lesions. This study evaluated hr-HPV infection dynamics and genotype specific outcomes over two years among Ethiopian women.Patients and Methods: A cohort of 893 women aged 30– 49 years was followed for two years using self-collected samples for multiplexed hr-HPV genotyping by BSGP5+/6+ PCR. Women testing positive were re-evaluated at 6 and 24 months with HPV genotyping, Visual Inspection with Acetic Acid (VIA) and cytology. Persistent infection was defined as continuous HPV DNA presence over consecutive visits, while clearance indicated no detectable virus. Re-infection occurred if a cleared HPV type reappeared, or a new type was detected.Results: After six months, 26.3% had persistent infections, while 73.7% cleared the infection. After two years, 13.2% experienced persistence, and 86.8% cleared their infections. Among women who tested negative at baseline, 74 were re-tested and showed hr-HPV incidence of 4.05% after 24 months. Genotype persistence rates varied, with HPV68, 82, 53, 52, and 56 showing the highest persistence after six months. After 24 months, HPV59, 68, 66, 52, and 16 had the highest persistence. Additionally, 29.9% of women at six months had abnormal cytology, including Atypical squamous cells of undetermined significance (ASCUS) and High grade squamous intraepithelial lesion (HSIL), which was 10.3% of those tested.Conclusion: The findings show that most hr-HPV infections among rural Ethiopian women cleared within two years, with varying persistence and clearance rates across HPV types. This emphasizes the need for regular monitoring and targeted prevention in high HPV prevalence populations.Keywords: HPV, persistence, high-risk genotypes, natural history, cervical cancer, Ethiopia