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Table 3 Predictors of HR-HPV incidence and persistence in HIV-negative high-risk women with normal cytology, Kigali, Rwanda

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

 

Incidence1

Persistence2

 

Incident cases

Unadjusted OR (95% CI)

Adjusted OR (95% CI)

Persistent cases

Unadjusted OR (95% CI)

 

n/N

N = 296

N = 295

n/N

N = 90

Demographical and reproductive characteristics at baseline

Age

     

   < 30

75/243

1

1

27/81

1

   ≥ 30 yrs

7/53

0.34 (0.15-0.80)

0.44 (0.18-1.06)

2/9

0.57 (0.11-2.98)

Age at sexual debut

     

   < 15

10/39

1

 

2/16

1

   15-19

63/213

1.22 (0.56-2.65)

 

24/65

4.10 (0.82-20.50)

   ≥ 20

8/41

0.70 (0.24-2.04)

 

2/8

2.33 (0.24-22.27)

Parity

     

   < 3 pregnancies

58/188

1

 

18/62

1

   ≥ 3 pregnancies

24/108

0.64 (0.37-1.11)

 

11/28

1.58 (0.61-4.07)

HPV infection at Month 6 (first HPV measurement)

LR-HPV

     

   Negative

44/199

1

 

11/39

1

   Positive

38/97

2.27 (1.33-3.88)

 

18/51

1.39 (0.58-3.45)

HR-HPV co-infections3

     

   Negative

51/206

1

 

16/57

1

   Positive

31/90

1.59 (0.93-2.74)

 

13/33

1.67 (0.67-4.17)

HR HPV 33 and/or 52 and/or 584

     

   Negative

66/269

1

1

  

   Positive

16/27

4.47 (1.93-10.35)

4.10 (1.73-9.75)

  

Neisseria gonorrhoeae by PCR

     

   Negative

76/266

1

 

25/75

1

   Positive

5/23

0.69 (0.25-1.94)

 

4/9

1.73 (0.42-7.08)

Chlamydia trachomatis by PCR

     

   Negative

79/280

1

 

28/88

1

   Positive

2/12

0.51 (0.11-2.39)

 

1/2

2.14 (0.13-36.25)

Trichomonas vaginalis by InPouch culture

     

   Negative

74/245

1

 

24/72

1

   Positive

8/48

0.46 (0.20-1.04)

 

5/7

0.83 (0.26-2.66)

Syphilis serology

     

   Negative

75/272

1

 

27/81

1

   Positive

5/20

0.88 (0.31-2.50)

 

2/7

0.80 (0.14-4.44)

BV by Nugent score

     

   Normal (score 0-3)

35/127

1

 

11/31

1

   Intermediate flora (score 4-6)

5/39

0.39 (0.14-1.08)

 

4/11

1.04 (0.24-4.43)

   BV (score 7-10)

35/108

1.26 (0.72-2.21)

 

12/42

0.73 (0.27-1.99)

Genital co-infection at M12

Neisseria gonorrhoeae by PCR

     

   Negative

73/270

1

 

23/77

1

   Positive

9/25

1.52 (0.64-3.60)

 

6/13

2.1 (0.60-6.75)

Chlamydia trachomatis by PCR

     

   Negative

73/277

1

1

28/84

1

   Positive

9/18

2.79 (1.06-7.38)

2.90 (1.03-8.14)

1/6

0.40 (0.04-3.66)

Trichomonas vaginalis by InPouch culture

     

   Negative

76/273

1

 

26/80

1

   Positive

4/19

0.69 (0.22-2.15)

 

3/9

1.03 (0.24-4.52)

Syphilis serology

     

   Negative

79/275

1

 

27/82

1

   Positive

1/17

0.16 (0.02-1.21)

 

2/6

1.02 (0.17-5.97)

BV by Nugent score

     

   Normal (score 0-3)

30/123

1

 

17/32

1

   Intermediate flora (score 4-6)

11/33

1.55 (0.67-3.58)

 

2/8

0.29 (0.05-1.80)

   BV (score 7-10)

34/105

1.48 (0.83-2.66)

 

9/43

0.23 (0.08-0.69)

Current (Year 2) sexual and reproductive characteristics

Female sex worker (self-identified)6

     

   No

8/63

1

1

6/21

1

   Yes

74/233

3.20 (1.43-7.16)

3.01 (1.32-6.83)

23/69

1.25 (0.43-3.67)

Sexually active7

     

   No

4/24

1

 

1/8

1

   Yes

78/272

2.01 (0.66-6.10)

 

28/82

3.63 (0.41-21.96)

No. of clients in the past week

     

   0

8/62

1

 

6/21

1

   1-4

35/102

3.53 (1.47-8.46)

 

7/26

0.92 (0.25-3.37)

   5-9

17/61

2.61 (1.01-6.74)

 

5/19

0.89 (0.22-3.66)

   ≥ 10

22/70

3.09 (1.23-7.79)

 

11/24

2.12 (0.59-7.58)

No of vaginal sex acts in past month

     

   0

4/24

1

 

1/8

1

   1-24

50/176

1.98 (0.647-6.14)

 

13/48

2.60 (0.28-24.06)

   ≥ 25

28/90

2.26 (0.70-7.33)

 

15/32

6.18 (0.60-63.4)

Condom use during vaginal sex in the past month

     

   Always

21/66

1

 

4/14

1

   Never/inconsistent

56/199

0.84 (0.46-1.54)

 

23/65

1.37 (0.38-4.90)

   No sex

5/31

0.41 (0.14-1.25)

 

2/11

0.56 (0.08-4.01)

Hormonal contraceptive use8

     

   No

57/195

1

 

17/57

1

   Yes

23/98

0.74 (0.42-1.30)

 

12/32

1.41 (0.56-3.55)

BV by Nugent score

     

   Normal (score 0-3)

35/144

1

 

14/37

1

   Intermediate flora (4-6)

6/21

1.25 (0.45-3.47)

 

2/6

0.82 (0.13-5.20)

   BV (score 7-10)

38/124

1.38 (0.80-2.37)

 

13/46

0.65 (0.25-1.65)

Concurent LR HPV infection

     

   No

36/87

1

1

18/55

1

   Yes

46/209

2.50 (1.44-4.33)

2.41 (1.34-4.34)

11/35

0.94 (0.38-2.35)

HSV-2 serology

     

   Negative Enr-Year 2

26/96

1

 

6/19

1

   Positive at Enr

41/158

0.94 (0.53-1.68)

 

17/50

1.12 (01.36-3.49)

   Incident at Year 2

7/14

2.69 (0.84-8.60)

 

3/8

1.30 (0.22-7.58)

  1. 1 Incidence is composite grouped-type specific incident variable including HIV-negative women with normal cytology who develop at least one incident infection. Population at risk includes women with/without HR-HPV co-infection with other types than the type at interest; mean interval incidence 16.6 months (SD 1.8); 2 Persistence is a composite grouped-type-specific persistence variable, including HIV-negative women with normal cytology who are at risk of at least one persistent infection. The population at risk includes women with/without HR-HPV co-infection with other types than the type at interest; mean interval ersistence 16.9 months (SD 1.7); 3 No HR-HPV infection at Month 6 compared to ≥ 1 types detected for HPV incidence model - and a single HR-HPV infection at Month 6 compared to ≥ 2 types for HPV persistence model; 4 Reference group: no HR-HPV at Month 6. Other prevalent HR-HPV types were not associated with acquisition of new HR HPV types; 5 Reference group: all others; 6 31/296 women in incidence model stopped sex work since last study visit - and 23/99 women in persistence analysis; 7 24/296 women reported no sexually activity at Year 2 visit in incidence analysis; 8/99 reported no sexual activity at Year 2 visit in persistence analysis; 8 Oral contraceptives, injectables or implants
  2. Abbreviations: HR-HPV = high-risk human papillomavirus infection; LR-HPV = low-risk HPV; HIV = human immunodeficiency virus; OR = odds ratio; CI = confidence interval; HSV-2 = herpes simplex virus type 2; ASCUS = atypical squamous cells of undetermined significance; Sample sizes for different questions may vary slightly from the total N based on missing responses.
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BMC Infectious Diseases

ISSN: 1471-2334

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