Association between human papillomavirus and behaviour, clinicopathology, and cervical cancer outcome in Zimbabwean women: a cross-sectional study.

BACKGROUND

Less than 10% of women infected with distinct human papillomavirus (HPV) develop cervical cancer, suggesting the need for secondary driving factors for carcinogenesis. This study describes factors associated with distinct HPV infections using cervical cancer cohort as a model. Moreover, we also determined the role of distinct HPV in the outcome of cervical cancer therapy.

METHODS

This cross-sectional study comprised of 240 Zimbabwean women aged > 18 years with histologically confirmed cervical cancer. Tumour tissue was obtained for genomic DNA analysis of 14 HPV genotypes. Demographic, behavioural and clinical information of study participants were collected for analysis. Logistic regression was used to determine factors associated with HR-HPV positivity, and outcomes of therapy.

RESULTS

The mean age(SD) of the group was 52(12) years. High HIV-positivity (48%) and sexually transmitted infection history (30%) were observed. HPV16 (35%), HPV35 (33%) and HPV18 (32%) were most prevalent. In unadjusted analyses, STI history (OR = 2.5, 95% CI 1.8-4.4, p < 0.01) was associated with HPV51 infections. Alcohol consumption was associated with HPV35 (OR = 1.93, 95% CI 1.1-4.9, p = 0.049) and HPV58 (OR = 2.5, 95% CI 1.6-3.8, p = 0.030). Smoking history was associated with HPV39 (OR = 5.8, 95% CI 2.0-7.8, p = 0.001) and HPV56 (OR = 2.0, 95% CI 1.2-4.3 p = 0.001). In adjusted analyses, HPV35 positivity was associated with high BMI (aOR = 1.4; 95% CI 1.1-1.7, p = 0.010). No HPV was associated with outcome.

CONCLUSIONS

We describe the association between high BMI and smoking with distinct HPV genotypes. There is need for further research in a larger cohort to build predictive algorithms towards strengthening existing preventive, screening and predictive outcome interventions for HPV.