Epidemiology of human papillomavirus among women living with HIV in rural Uganda: a retrospective cohort study

BACKGROUND: Persistent human papillomavirus (HPV) infection is a significant precursor to cervical abnormalities and invasive cancer. While the causal relationship between specific HPV types and cervical cancer is established, little is known about the distribution of HPV types among women living with HIV (WLWH) in Uganda. We aimed to describe the epidemiology of HPV types among women living with HIV at Mityana and Kiboga Hospitals in rural central Uganda. METHODS: A retrospective review of demographic and clinical data, including age and antiretroviral therapy (ART) history, was conducted among WLWH tested for HPV between July 2021 and July 2022. GeneXpert HPV DNA real-time Polymerase Chain Reaction assay (RT-PCR) detected HPV 16, 18/45, and other pooled high-risk types (31, 33, 35, 39, 51, 52, 56, 58, 59, 66, and 68). HPV infections were categorized into single and multiple subtypes. Statistical analysis involved Chi-square tests and modified Poisson regression with robust standard error models to evaluate associations and identify factors linked with HPV infection. RESULTS: Among 1305 WLWH, the overall prevalence of HPV infection was 39.1%. HPV16 and HPV18/45 were the most common genotypes, with a prevalence of 8.1% and 8.2%, respectively. Multiple HPV infections were observed in 18.4% of cases, with combinations of HPV 16, HPV 18/45, and other high-risk HPV types. Increasing age was significantly associated with a lower prevalence of HPV infection (PR = 0.97; 95% CI: 0.95-0.99; p = 0.003). CONCLUSION: A high prevalence of genital high-risk HPV infection was observed among WLWH attending ART clinics in public health facilities in Uganda. Other high-risk HPV types were the most frequently detected, compared to HPV18/45 and HPV16. The high prevalence of high-risk HPV among WLWH, particularly among younger age groups, highlights the need to integrate HPV screening within routine HIV care services and to strengthen targeted prevention strategies, including vaccination and early screening in rural settings.