High Burden of High-Risk Human Papillomavirus Infections Among Women Living With HIV in Meru, Kenya.

Background Cervical cancer remains a major cause of death among women in Kenya and is primarily driven by persistent infection with high-risk human papillomavirus (HR-HPV). HIV infection increases the burden of the disease, as it is associated with higher rates of HPV acquisition and persistence and an increased risk of cervical cancer. Meru County in Kenya is among the regions with a high burden of this cancer, and preventive measures against HR-HPV infections remain limited in this region. It is important to understand the genotype distribution of these infections to guide effective prevention and screening. The prevalence and distribution of circulating HPV genotypes have not been thoroughly characterized, which hinders the development of targeted preventive measures. We therefore aimed to determine the prevalence and genotype distribution of HR-HPV and to assess sociodemographic, behavioral, and clinical factors associated with HR-HPV infection among women living with HIV (WLWHIV) in Meru, Kenya. Methods We conducted a cross-sectional study at Meru Teaching and Referral Hospital, Kenya. A total of 303 consenting WLWHIV attending the HIV comprehensive care center at the hospital, aged 18-50 years, were recruited into the study. A structured questionnaire was used to collect data on sociodemographic, health, and behavioral characteristics. High vaginal swabs were collected from the participants and tested for HR-HPV using real-time PCR. All participants were initially screened for HR-HPV, and samples that tested positive for undifferentiated high-risk types were further confirmed by real-time PCR genotyping. Statistical analyses were performed in R (version 4.3.5). Results The overall prevalence of HR-HPV was 60.4% (183/303). The most frequent genotypes were HPV 18, detected in 111/303 (36.6%), HPV 45 (96/303, 31.7%), and HPV 16 (37/303, 12.2%). Women who had other high-risk types accounted for 44/303 (14.9%), with HPV 59 detected as the most common genotype (22/44, 50%), followed by HPV 35 (19/44, 43%) and HPV 68 (13/44, 29.5%). Younger women (18-44 years) had more HR-HPV infections compared to older women (45-50 years). Univariate analysis showed an association between HR-HPV and age (p = 0.022), as well as previous cervical cancer screening (p = 0.04), but these associations did not remain significant in multivariate analysis (age: OR = 1.01; 95% CI: 0.91-1.11; p = 0.90; previous cervical cancer screening: OR = 1.21; 95% CI: 0.63-2.32; p = 0.60). Conclusion The high prevalence of HR-HPV, dominated by HPV 18, 45, and 16, highlights the importance of strengthening HPV vaccination, screening, and awareness programs among women living with HIV. The higher prevalence observed among younger women further supports the need for targeted early prevention and screening strategies in this population.