Molecular epidemiology of human papillomavirus genotypes among HIV-negative women and women living with HIV with cervical cancer in two regions in Nigeria

Abstract

Background

Cervical cancer (CC) is highly prevalent in Nigeria, with over 12,000 cases and 8000 deaths annually. Differences in diagnostic methods for human papillomavirus (HPV) genotypes have generated varied prevalence rates across populations.

Methods

We analyzed the prevalence and distribution of high-risk HPV (HR-HPV) genotypes among women with CC, comparing HIV-negative women and women living with HIV (WLWH), using data from a prospective Nigerian cohort study (2018–2022). High-throughput next-generation sequencing (NGS) of the HPV L-1 gene identified and classified genotypes.

Results

Among 189 women tested for HR-HPV, 74.1% (140/189) were HIV-negative, and 25.9% (49/189) were WLWH. The median age was lower for WLWH at 48 years [IQR: 41–54] compared to HIV-negative women at 60 years [IQR: 49–69] (p < .001). The overall prevalence of HR-HPV was 64.6% (122/189; 95% CI: 57.4–71.1), with higher rates in WLWH (77.6%, 38/49) than HIV-negative women (60.0%, 84/140) (p < .001). Among HR-HPV-positive cases, HPV16 or HPV18 accounted for the highest proportion, representing 67.2% (95% CI: 58.3–75.0). The most prevalent HR-HPV types detected were HPV16 (46.7%), HPV18 (20.5%), HPV45 (9.8%), HPV35 (6.6%), and HPV52 (5.7%). Quadrivalent and nonavalent HPV vaccines would cover 67.2% (95% CI: 58.3–75.0) and 86.1% of HR-HPV infections, respectively.

Conclusion

Our NGS approach findings among women with CC identified HPV types not covered by the Gardasil-4 vaccine used in Nigeria. This highlights the need for broader vaccine coverage against most HR-HPV types, regardless of HIV status, in Nigeria.