Open Access Research article

Genital warts and infection with human immunodeficiency virus in high-risk women in Burkina Faso: a longitudinal study

Andrea J Low1*, Tim Clayton1, Issouf Konate2, Nicolas Nagot3, Abdoulaye Ouedraogo1, Charlotte Huet2, Marie-Noelle Didelot-Rousseau3, Michel Segondy3, Philippe Van de Perre3, Philippe Mayaud12 and the Yérélon Cohort Study Group

Author Affiliations

1 London School of Hygiene & Tropical Medicine, London, UK

2 Centre Muraz, Bobo-Dioulasso, Burkina Faso

3 Université Montpellier 1, EA 4205 « Transmission, Pathogenèse et Prévention de l'Infection par le VIH »; and CHU Montpellier, Laboratoire de Bactériologie-Virologie and Département d'Information Médicale, Montpellier, France

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BMC Infectious Diseases 2011, 11:20  doi:10.1186/1471-2334-11-20

Published: 20 January 2011

Abstract

Background

Human papillomaviruses are the most common sexually transmitted infections, and genital warts, caused by HPV-6 and 11, entail considerable morbidity and cost. The natural history of genital warts in relation to HIV-1 infection has not been described in African women. We examined risk factors for genital warts in a cohort of high-risk women in Burkina Faso, in order to further describe their epidemiology.

Methods

A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso. Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections. In a subset of 306 women, cervical HPV DNA was tested at enrolment.

Results

Genital wart prevalence at baseline was 1.6% (8/492) among HIV-uninfected and 7.0% (19/273) among HIV-1 seropositive women. Forty women (5.2%) experienced at least one incident GW episode. Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤200 cells/μL. Incident genital warts were also associated with concurrent bacterial vaginosis, and genital ulceration. Antiretroviral therapy was not protective against incident or persistent genital warts. Detection of HPV-6 DNA and abnormal cervical cytology were strongly associated with incident genital warts.

Conclusions

Genital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population.