Prevalence and genotype-specific distribution of Human papillomavirus in Burundi according to HIV status and urban or rural residence and its implications for control

Background: Human papillomaviruses are the most important causative agents for invasive cervical cancer development. HPV type-specific vaccination and HPV cervical cancer screening methods are being widely recommended to control the disease but the epidemiology of the circulating HPV types may vary locally. The circulating HPV-strains have never been assessed in Burundi. This study determined the prevalence and genotype-specific distribution of HPV in four different strata in Burundi: HIV-infected or non-infected and women living in rural or urban areas. Implications for HPV diagnosis and vaccine implementation was discussed. Methods Four cross-sectional surveys were conducted in Burundi (2013 in a rural area and 2016 in urban area) among rural and urban HIV-infected and uninfected women. Cytology and HPV genotyping was performed to screen women for cervical cancer lesions. Risk factors for HPV infection and cervical cancer lesions were determined using logistic regression model. Results HPV prevalence was very high in urban area with significant differences between HIV-positive and negative women (p<0.0001). In fact, 45.7% of HIV-positive participants were infected with any HPV type and all were infected with at least one HR/pHR-HPV type. Among the HIV-negative participants, 13.4% were HPV-infected, of whom, only 4 women (2.7%) were infected with HR/pHR-HPV types. In rural, HPV infection did not significantly differ between HIV-positive and negative women (30.0% and 31.3% respectively; p=0.80). In urban, multiple infections with HR/pHR-HPV types were detected in 13.9% and 2.7% among HIV-positive and negative women respectively (p<0.0001), whereas in rural, multiple infections with HR/pHR-HPV types were detected in 4.7% and 3.3% of HIV positive and negative women respectively (p=0.56). The most prevalent HR/pHR-HPV types in HIV-positive urban women were HPV 52, 51 and 56. In the HIV-negative urban women, the most prevalent HR/pHR-HPV types were HPV 66, 67 and 18. In HIV-positive rural women, the most prevalent HR/pHR-HPV types were HPV 66, 16 and 18. In the HIV-negative rural women, the most prevalent HR/pHR-HPV types were HPV 16, 66 and 18. Independent risk factors associated with cervical lesions were HPV and HIV infections. Conclusions There is a high burden of HR/pHR-HPV infections, in particular among HIV-infected urban women. The study points out the need to introduce a comprehensive cervical cancer control program adapted to the context. This study shows that the nonavalent vaccine covers most of the HR/pHR-HPV infections in rural and urban areas among HIV-infected and uninfected women.