Risk factors associated with human papillomavirus prevalence and cervical neoplasia among Cameroonian women.

BACKGROUND

This study used community-based cervical cancer screening for high-risk human-papillomavirus (HPV) to determine demographic and lifestyle factors associated with HPV prevalence and cervical intraepithelial neoplasia grade 2 or worse (CIN2+).

METHODS

Women (n=838) aged 25-65 years were recruited in two sequential studies in Cameroon. Demographic and historical data were obtained from participants and specimens were self-collected for HPV-testing using real-time PCR. HPV-positive women underwent biopsy and endocervical curettage. Associations were determined using bivariate analysis and logistic regression.

RESULTS

HPV and self-reported HIV prevalence were 39.0% and 9.2%, respectively. Eighteen (9.3%) CIN2+ lesions were found among HPV-positive women. Housewives had a higher risk of being HPV infected (OR=1.60, p=0.010). HIV co-infection (aOR=3.44, p<0.001) and hormonal contraception (aOR=1.97, p=0.007) were associated with increased HPV prevalence. HPV-positive women who used condoms during sexual intercourse were at lower risk of CIN2+ (aOR=0.15, p=0.029). CIN2-3 lesions were found in women younger than 50 years, with a median age of 36 years (31-44). HPV-16/18-positive women had a 4.65-fold increased risk of CIN2+ (p=0.015).

CONCLUSIONS

Young, single women and housewives were at higher risk of HPV infection. Preventive strategies for cervical cancer in low-resource settings should target women aged 30-50 years for HPV screening, and should focus treatment and follow-up on HPV-16/18-positive women. Further studies are needed to clarify if other risk factors require attention.