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The epidemiology of human papillomavirus infection in HIV-positive and HIV-negative high-risk women in Kigali, Rwanda

Nienke J Veldhuijzen1*, Sarah L Braunstein2, Joseph Vyankandondera34, Chantal Ingabire3, Justin Ntirushwa3, Evelyne Kestelyn13, Coosje Tuijn5, Ferdinand W Wit1, Aline Umutoni3, Mireille Uwineza3, Tania Crucitti6 and Janneke HHM van de Wijgert13

Author Affiliations

1 Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD), the Netherlands

2 Columbia University, New York, USA

3 Projet Ubuzima, Kigali, Rwanda

4 Belgium Technical Cooperation, Kigali, Rwanda

5 Royal Tropical Institute, Amsterdam, the Netherlands

6 Institute of Tropical Medicine, Antwerp, Belgium

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BMC Infectious Diseases 2011, 11:333  doi:10.1186/1471-2334-11-333

Published: 2 December 2011



The prevalence, incidence and persistence of human papillomavirus (HPV) types in sub-Saharan Africa are not well established. The objectives of the current study are to describe (predictors of) the epidemiology of HPV among high-risk women in Kigali, Rwanda.


HIV-negative, high-risk women were seen quarterly for one year, and once in Year 2. HIV serostatus, clinical, and behavioral information were assessed at each visit, HPV types at Month 6 and Year 2, and other sexually transmitted infections (STI) at selected visits. HPV prevalence was also assessed in HIV-positive, high-risk women.


Prevalence of any HPV was 47.0% in HIV-negative women (median age 25 years) compared to 72.2% in HIV-positive women (median age 27 years; OR 2.9, 95% CI 1.9-4.6). Among HIV-negative women, cumulative incidence of high-risk (HR)-HPV was 28.0% and persistence 32.0% after a mean period of 16.6 and 16.9 months, respectively. Prior Chlamydia trachomatis and Neisseria gonorrhoeae infection, concurrent low-risk (LR)-HPV infection and incident HSV-2 were associated with HR-HPV prevalence among HIV-negative women; prior C. trachomatis infection and co-infection with LR-HPV and HPV16-related HPV types with HR-HPV acquisition. HPV16-related types were the most prevalent and persistent.


High HPV prevalence, incidence and persistence were found among high-risk women in Kigali. HPV52 had the highest incidence; and, together with HPV33 and HPV58, were strongly associated with acquisition of other HR-HPV types in HIV-negative women.