Rapid Acquisition of HPV Around the Time of Sexual Debut in Adolescent Girls in Tanzania
BACKGROUND:
No
reports exist on genotype-specific human papillomavirus (HPV) acquisition in
girls after first sex in sub-Saharan Africa, despite high HPV prevalence and
cervical cancer incidence.
METHODS:
We
followed 503 HP-unvaccinated girls aged 15-16 years in Mwanza, Tanzania,
3-monthly for 18 months with interviews and self-administered vaginal swabs.
Swabs were tested for 13 higHRisk and 24 low-risk HPV genotypes. Incidence,
clearance and duration of overall HPV and genotype-specific infections were
calculated and associated factors evaluated.
RESULTS:
A total
of 106 participants reported first sex prior to enrolment (N = 29) or during
follow-up (N = 77). One was HIV-positive at the final visit. The remaining 105
girls contributed 323 adequate specimens. Incidence of any new HPV genotype was
225/100 person-years (pys), and incidence of vaccine types HPV-6, -11, -16 and
-18 were 12, 2, 2 and 7/100 pys, respectively. Reporting sex in the past 3
months and knowing the most recent sexual partner for a longer period before
sex were associated with HPV acquisition. Median time from reported sexual
debut to first HPVinfection was 5 months, and infection duration was 6 months.
CONCLUSION:
This
is the first description of HPV acquisition after first sex in sub-Saharan
Africa where the incidence of cervical cancer is amongst the highest in the
world. HPV incidence was very high after first sex, including some vaccine
genotypes, and infection duration was short. This very high HPV incidence may
help explain high cervical cancer rates, and supports recommendations that the
HPV vaccine should be given to girls before first sex.
Below: Time from sexual debut to first infection with any HPV, any
HR HPV or any LR HPV, among 41 girls who reported sexual debut during follow-up
and were HPV-naïve at time of reported sexual debut. Kaplan Meier curves are calculated separately
for each HPV group.
- 1Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK Mwanza Intervention Trials Unit, Mwanza, Tanzania catherine.houlihan@lshtm.ac.uk.
- 2MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
- 3Unit of Infections and Cancer, Institut Català d'Oncologia, Barcelona, Spain.
- 4Mwanza Intervention Trials Unit, Mwanza, Tanzania MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
- 5Unit of Infections and Cancer, Institut Català d'Oncologia, Barcelona, Spain CIBER ESP, Barcelona, Spain.
- 6National Institute for Medical Research, Mwanza, Tanzania.
- 7Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK Mwanza Intervention Trials Unit, Mwanza, Tanzania.
- Int J Epidemiol. 2016 Mar 4. pii: dyv367.
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