High blood pressure is a heritable risk factor for cardiovascular disease, stroke and other chron... more High blood pressure is a heritable risk factor for cardiovascular disease, stroke and other chronic conditions. There is an increasing prevalence of high blood pressure in sub-Saharan Africa. We aimed to identify genetic variants underlying blood pressure traits in Sub-Saharan Africa. We conducted a GWAS, meta-analyses and gene-set analyses of blood pressure traits (systolic, diastolic, pulse pressure), in African populations. We used the African Collaborative Center for Microbiome and Genomics Research data (ACCME, n=~15,000) for GWAS discovery and the Africa America Diabetes Mellitus study data (AADM, n=~5,200), for GWAS replication. Multiple SNPs were identified reaching genome-wide significance. The lead SNP from the elevated blood pressure group was on chromosome 16 (rs148403740, minor allelic frequency (MAF)=0.0176, p= 9.28x10 -9 , odds ratio(OR)= 2.58) nearest to the MGRN1 gene. The lead SNP from the hypertension stage 1 group was on chromosome 7 (rs4236415, MAF= 0.4912, p= 1...
Genetic variants that underlie susceptibility to high-risk cervical human papilloma virus (hrHPV)... more Genetic variants that underlie susceptibility to high-risk cervical human papilloma virus (hrHPV) infections are largely unknown. We conducted discovery case-case and case-control genome-wide association studies, replication, and meta-analysis, generated polygenic risk scores and examined the association of classical HLA alleles and cervical human papillomavirus (HPV) infections in a cohort of over 10,000 women. We identified genome-wide significant variants for prevalent hrHPV around LDB2 and for persistent hrHPV near TPTE2, SMAD2, and CDH12, which code for proteins that are significantly expressed in the human endocervix. Genetic variants associated with persistent hrHPV are in genes enriched for the antigen processing and presentation gene-set. HLA-DRB1*13:02, HLA-DQB1*05:02 and HLA-DRB1*03:01 were associated with increased risk and HLA-DRB1*15:03 with decreased risk of persistent hrHPV. The findings of this study expand our understanding of genetic risk factors for HPV persisten...
Global data on age-specific prevalence of human papillomavirus (HPV) infection in males, especial... more Global data on age-specific prevalence of human papillomavirus (HPV) infection in males, especially for oncogenic HPV types 16 and 18, are essential for future efforts to prevent HPV-related diseases, including expanded access to HPV prophylactic vaccines for boys and young men. A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in men. Studies using polymerase chain reaction or hybrid capture detection assays were included. Approximately 6,600 abstracts were identified. Of them, 64 reported age-specific HPV prevalence and were included in the review. Of these, 38 were from populations at high risk of HPV infections, such as sexually transmitted infection clinic attendees, human immunodeficiency virus-positive males, and male partners of women with HPV infection or abnormal cytology. The largest proportions of studies were from Europe (38%) and North America (25%), with smaller proportions from Central and South America (19%), Asia (11%), and Africa (5%). Across all regions, data on HPV prevalence were generally limited to men >18 years of age. HPV prevalence was high among sexually active men in all regions but with considerable variation, from 1% to 84% among low-risk men and from 2% to 93% among high-risk men. Peak HPV prevalence spanned a wide range of ages and was generally not concentrated in the younger age groups. Age-specific prevalence curves were relatively flat or declined only slightly following peak prevalence. Genital HPV infection in men varies widely, both between and within high- and low-risk groups and by geographic region. Compared with that in women, HPV prevalence in men seems to peak at slightly older ages and remains constant or decreases slightly with increasing age, suggesting persistent HPV infection or a higher rate of reinfection.
Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of t... more Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of the epidemiology and genomics of breast cancer and its molecular subtypes in these countries have been done. The African Female Breast Cancer Epidemiology (AFBRECANE) study, a part of the Human Heredity and Health in Africa (H3Africa) initiative, is designed to study the genomics and epidemiology of breast cancer and its molecular subtypes in Nigerian women. We link recruitment of breast cancer cases at study sites with population-based cancer registries activities to enable ascertainment of the incidence of breast cancer and its molecular subtypes. We use centralized laboratory processing to characterize the histopathological and molecular diagnosis of breast cancer and its subtypes using multiple technologies. By combining genome-wide association study (GWAS) data from this study with that generated from 12,000 women participating in our prospective cohort study of cervical cancer, we c...
e11030 Background: Ki-67 is a nuclear protein expressed during all active phases of the cell cycl... more e11030 Background: Ki-67 is a nuclear protein expressed during all active phases of the cell cycle and is an excellent marker for determining the growth fraction of tumor cell populations. There is a paucity of African studies correlating Ki67 with pathological parameters of breast cancer. The aim of this study was to correlate Ki-67 index with histological grade of breast carcinoma. METHODS This is a prospective analysis of 101 breast cancer cases from the surgical oncology unit of the University College Hospital Ibadan over a twelve months period from March 2008 to February 2009. Breast carcinomas were graded using the Scarff-Bloom-Richardson (SBR) and Van Nuys (VN) methods. Ki-67 immunohistochemical assay was performed using a novel technique and correlated with conventional Scarff-Bloom-Richardson (SBR) and Van Nuys (VN) grading parameters. RESULTS Ki67 expression ranged from 0-95% with a mean of 36 ± 24%. There was significant correlation between Ki67 expression and SBR mitotic score (p = 0.03) and a weak non significant correlation with composite SBR grade (p = 0.06). There was also a significant correlation between Ki67 expression and VN nuclear score (p = 0.05) and presence of extensive tumor necrosis (p = 0.03. CONCLUSIONS The present study has displayed the feasibility of accurate and reproducible assessment of Ki67 immunohistochemical staining in breast cancer tissue using a novel technique. It is recommended that further studies should be performed in order to investigate the role of Ki67 and other prognostic markers in determining clinical outcome in patients with breast cancer in this environment.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
Background:Different trends have been reported on the age prevalence of HPV in Africa. The result... more Background:Different trends have been reported on the age prevalence of HPV in Africa. The results of some studies showed there was a high peak of HPV prevalence among younger women, which decreased with age, but among older women the prevalence either decreased, reached a plateau or increased. There is scare data on the relation between persistent HPV infection and age. Methods:Women presenting at cervical cancer screening programs in Abuja, Nigeria between 2012 and 2014 were enrolled, data on demographic characteristics, risk factors of HPV infection and samples of cervical exfoliated cells were collected at baseline, 6 and 12 months follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as positive results on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and the risk of HPV infections. Results:We enrolled 1020 women, their mean (SD) age was 37 (8), the prevalence of any HPV and persistent HPV was 53% and 17%, respectively. The women were dichotomized into age groups, young: 18–35 (42%) and older: >35 years (58%). The prevalence of any HPV infection was 47% among the young women and 53% among the older women, P-value = 0.004. The prevalence of persistent HPV infection was 44% among the young women and 56% among the older women, P-value = 0.67. The multivariate odds ratio (OR) and 95% confidence interval (95% CI) among the young women was 1.30 (95% CI: 0.85 to 1.16, P-value 0.06) for any HPV infection and 0.84 (95% CI: 0.58 to 1.21, P-value 0.35) for persistent HPV infection, compared to older women. Conclusions:These results suggest that the pattern of HPV persistence among young and older women is not different. We will present the results on type specific HPV infection stratified by age, at the upcoming meeting.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
Background:Cervical cancer incidence has remained stable in HIV+ women but the prevalence, persis... more Background:Cervical cancer incidence has remained stable in HIV+ women but the prevalence, persistence and multiplicity of HPV infection appears different comparing HIV+ to HIV− women. We examined the association between HIV, prevalent and persistent HPV infections among women in a prospective cohort in Nigeria. Methods:Women were recruited from cervical cancer screening programs in Abuja, Nigeria between 2012 and 2014, data on demographic characteristics, risk factors of HPV infection and samples of cervical exfoliated cells were collected at baseline, 6 and 12 months follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as positive results on 2 consecutive DEIA tests. Logistic regression models were used to estimate the association between HIV and the risk of HPV infections. Results:Among the 1020 women enrolled, the mean age (±SD) was 37 (8), 44% and 56% were HIV+ and HIV-, respectively. The prevalence of any HPV infection was 53% (58% among HIV+; 42% among HIV−, P-value <0.001); the prevalence of persistent HPV infection was 17% (78% among HIV+; 22% among HIV−, P-value <0.001). The multivariate relative risk and 95% confidence interval (95% CI) was 3.22 (95% CI: 2.40 to 4.32, P-value <0.001) for any HPV infection and 5.52 (95% CI: 3.61 to 8.44, P-value <0.001) for persistent HPV infection, comparing HIV+ to HIV− women, adjusted for variables that reached statistical significance in univariate analyses: age, age at sexual initiation, number of lifetime sexual partners, marital status and level of education. Conclusions:HIV infection is associated with increased risk of any HPV and persistent HPV infections. Previously, we reported that the most prevalent high risk HPV types were HPV35 (8.7%) and HPV56 (7.4%) among HIV+ women, and HPV52 and HPV68 (2.8%, each) among HIV- women, from a subset of this population. We will present the results of the specific HPV types in the entire study population, at the forthcoming conference.
The microbiota plays an important role in prevention of colonization of the vagina by pathogenic ... more The microbiota plays an important role in prevention of colonization of the vagina by pathogenic organisms such as HIV, Herpes simplex virus and N. gonorrhea. Given the role of persistent high risk HPV (hrHPV) infection of the cervix as a necessary but not sufficient cause of cervical, we hypothesized that in addition to other risk factors, specific community types of vaginal microbiota may be cofactors in the etiology of cervical cancer and pre-cancer (CIN2+). We enrolled HIV+ and HIV- women who presented to our cervical cancer screening program at the National Hospital, Abuja and the University of Abuja Teaching Hospital, Abuja, Nigeria between April and August 2012 into this study. Using a nurse administered questionnaire, we collected information on demographics and risk factors of cervical cancer. Without cleaning the introitus, we collected mid-vaginal samples and cervical exfoliated cells from all participants. We characterized the vaginal microbiota from the mid-vaginal samp...
The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomav... more The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomavirus (hrHPV) infection. We examined the relationship between the vaginal microbiota and persistent hrHPV infection in HIV-negative and HIV-positive women. We used 16S-rRNA sequencing to characterize the vaginal microbiota of two serial samples taken six months apart from 211 Nigerian women (67%, 142/211 HIV-positive and 33%, 69/211 HIV-negative) and evaluated the association between the vaginal microbiota and persistent hrHPV infection using generalized estimating equation logistic regression models and linear discriminant analysis effect size (LEfSe) algorithm to identify phylotypic biomarkers of persistent hrHPV infection. The high diversity microbiota, Community State Type IV-B, was the most prevalent in both HIV-negative (38% at baseline, 30% at the follow-up visit) and HIV-positive (27% at baseline, 35% at the follow-up visit) women. The relationship between the vaginal microbiota a...
Purpose There is a dearth of data on clearance of cervical human papillomavirus (HPV) infection a... more Purpose There is a dearth of data on clearance of cervical human papillomavirus (HPV) infection among women in West Africa. We examined the clearance of low-risk (lr) and high-risk (hr) cervical HPV infections, and the factors associated with these measures in HIV-negative and HIV-positive women. Methods We studied 630 Nigerian women involved in a study of HPV infection using short polymerase chain reaction fragment-10 assay and line probe assay-25. Research nurses used a cervical brush to collect samples of exfoliated cervical cells from all the study participants. Cox proportional hazards models were used to estimate associations between HIV and HPV infections. Results The mean age of the study participants was 38 (standard deviation, ± 8) years; 51% were HIV positive. The rate of clearing any HPV infection was 2.0% per month among all women in the study population, 2.5% per month among HIV-negative women, and 1.6% per month, among HIV-positive women. The clearance rate per 1,000 ...
The prevalence, persistence, and multiplicity of human papillomavirus (HPV) infection appears dif... more The prevalence, persistence, and multiplicity of human papillomavirus (HPV) infection appears different comparing HIV-positive to HIV-negative women. In this study, we examined prevalent, persistent, and multiple low- and high-risk cervical HPV infections in HIV-negative and HIV-positive women. We studied 1,020 women involved in a study of HPV infection using SPF25/LiPA10. Two study visits were scheduled, at enrollment and 6 months afterward. At each study visit, research nurses used a cervical brush to collect samples of exfoliated cervical cells from the cervical os, from all the study participants. Exact logistic regression models were used to estimate associations between HIV and HPV infections. The mean (SD) age of the study participants was 38 (8) years, 56% were HIV-negative and 44% were HIV-positive. Among HIV-negative women at baseline, single low-risk HPV (lrHPV) infections occurred in 12%; multiple lrHPV in 2%; single high-risk human papillomavirus (hrHPV) infections in 9...
64 Background: The incidence, prevalence, persistence, and multiplicity of high-risk HPV infectio... more 64 Background: The incidence, prevalence, persistence, and multiplicity of high-risk HPV infection is different between HIV positive and HIV negative women. We examined the association between HIV, prevalent HPV, and persistent HPV infections among women in a prospective cohort in Nigeria. Methods: We enrolled women presenting at cervical cancer screening programs in Abuja, Nigeria, between 2012 and 2014 and collected information on their demographic characteristics, risk factors of HPV infection, and cervical exfoliated cells samples at baseline, 6 month and 12 month follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as a positive result on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and risk of HPV infection. Results: Among the 1,020 women enrolled, the mean age (±SD) was 37(8), and 44% and 56% were HIV+ and HIV-, resp...
65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown a... more 65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown about the prevalence and pathogenicity of human papillomavirus (HPV) types and the mechanism of disease, and there is a need for new biomarkers for screening programs. Methods: ACCME is a multicenter prospective cohort study of host germline, somatic and HPV genomics and epigenomics, and vaginal microenvironment; and their association with cervical cancer in 10,000 HIV negative women in Nigeria. Data on demographic, lifestyle, medical history, serum, germline DNA, HPV genotype, and vaginal pH are collected at baseline and during follow up visits every 6 months. Samples of exfoliated cervical cells are analyzed for high risk HPV with Roche LINEAR ARRAY and vaginal bacterial composition and abundance are characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on a Illumina MiSeq platform. Colposcopies and biopsies are conducted on participants with clinical lesions and tho...
High blood pressure is a heritable risk factor for cardiovascular disease, stroke and other chron... more High blood pressure is a heritable risk factor for cardiovascular disease, stroke and other chronic conditions. There is an increasing prevalence of high blood pressure in sub-Saharan Africa. We aimed to identify genetic variants underlying blood pressure traits in Sub-Saharan Africa. We conducted a GWAS, meta-analyses and gene-set analyses of blood pressure traits (systolic, diastolic, pulse pressure), in African populations. We used the African Collaborative Center for Microbiome and Genomics Research data (ACCME, n=~15,000) for GWAS discovery and the Africa America Diabetes Mellitus study data (AADM, n=~5,200), for GWAS replication. Multiple SNPs were identified reaching genome-wide significance. The lead SNP from the elevated blood pressure group was on chromosome 16 (rs148403740, minor allelic frequency (MAF)=0.0176, p= 9.28x10 -9 , odds ratio(OR)= 2.58) nearest to the MGRN1 gene. The lead SNP from the hypertension stage 1 group was on chromosome 7 (rs4236415, MAF= 0.4912, p= 1...
Genetic variants that underlie susceptibility to high-risk cervical human papilloma virus (hrHPV)... more Genetic variants that underlie susceptibility to high-risk cervical human papilloma virus (hrHPV) infections are largely unknown. We conducted discovery case-case and case-control genome-wide association studies, replication, and meta-analysis, generated polygenic risk scores and examined the association of classical HLA alleles and cervical human papillomavirus (HPV) infections in a cohort of over 10,000 women. We identified genome-wide significant variants for prevalent hrHPV around LDB2 and for persistent hrHPV near TPTE2, SMAD2, and CDH12, which code for proteins that are significantly expressed in the human endocervix. Genetic variants associated with persistent hrHPV are in genes enriched for the antigen processing and presentation gene-set. HLA-DRB1*13:02, HLA-DQB1*05:02 and HLA-DRB1*03:01 were associated with increased risk and HLA-DRB1*15:03 with decreased risk of persistent hrHPV. The findings of this study expand our understanding of genetic risk factors for HPV persisten...
Global data on age-specific prevalence of human papillomavirus (HPV) infection in males, especial... more Global data on age-specific prevalence of human papillomavirus (HPV) infection in males, especially for oncogenic HPV types 16 and 18, are essential for future efforts to prevent HPV-related diseases, including expanded access to HPV prophylactic vaccines for boys and young men. A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in men. Studies using polymerase chain reaction or hybrid capture detection assays were included. Approximately 6,600 abstracts were identified. Of them, 64 reported age-specific HPV prevalence and were included in the review. Of these, 38 were from populations at high risk of HPV infections, such as sexually transmitted infection clinic attendees, human immunodeficiency virus-positive males, and male partners of women with HPV infection or abnormal cytology. The largest proportions of studies were from Europe (38%) and North America (25%), with smaller proportions from Central and South America (19%), Asia (11%), and Africa (5%). Across all regions, data on HPV prevalence were generally limited to men &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;18 years of age. HPV prevalence was high among sexually active men in all regions but with considerable variation, from 1% to 84% among low-risk men and from 2% to 93% among high-risk men. Peak HPV prevalence spanned a wide range of ages and was generally not concentrated in the younger age groups. Age-specific prevalence curves were relatively flat or declined only slightly following peak prevalence. Genital HPV infection in men varies widely, both between and within high- and low-risk groups and by geographic region. Compared with that in women, HPV prevalence in men seems to peak at slightly older ages and remains constant or decreases slightly with increasing age, suggesting persistent HPV infection or a higher rate of reinfection.
Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of t... more Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of the epidemiology and genomics of breast cancer and its molecular subtypes in these countries have been done. The African Female Breast Cancer Epidemiology (AFBRECANE) study, a part of the Human Heredity and Health in Africa (H3Africa) initiative, is designed to study the genomics and epidemiology of breast cancer and its molecular subtypes in Nigerian women. We link recruitment of breast cancer cases at study sites with population-based cancer registries activities to enable ascertainment of the incidence of breast cancer and its molecular subtypes. We use centralized laboratory processing to characterize the histopathological and molecular diagnosis of breast cancer and its subtypes using multiple technologies. By combining genome-wide association study (GWAS) data from this study with that generated from 12,000 women participating in our prospective cohort study of cervical cancer, we c...
e11030 Background: Ki-67 is a nuclear protein expressed during all active phases of the cell cycl... more e11030 Background: Ki-67 is a nuclear protein expressed during all active phases of the cell cycle and is an excellent marker for determining the growth fraction of tumor cell populations. There is a paucity of African studies correlating Ki67 with pathological parameters of breast cancer. The aim of this study was to correlate Ki-67 index with histological grade of breast carcinoma. METHODS This is a prospective analysis of 101 breast cancer cases from the surgical oncology unit of the University College Hospital Ibadan over a twelve months period from March 2008 to February 2009. Breast carcinomas were graded using the Scarff-Bloom-Richardson (SBR) and Van Nuys (VN) methods. Ki-67 immunohistochemical assay was performed using a novel technique and correlated with conventional Scarff-Bloom-Richardson (SBR) and Van Nuys (VN) grading parameters. RESULTS Ki67 expression ranged from 0-95% with a mean of 36 ± 24%. There was significant correlation between Ki67 expression and SBR mitotic score (p = 0.03) and a weak non significant correlation with composite SBR grade (p = 0.06). There was also a significant correlation between Ki67 expression and VN nuclear score (p = 0.05) and presence of extensive tumor necrosis (p = 0.03. CONCLUSIONS The present study has displayed the feasibility of accurate and reproducible assessment of Ki67 immunohistochemical staining in breast cancer tissue using a novel technique. It is recommended that further studies should be performed in order to investigate the role of Ki67 and other prognostic markers in determining clinical outcome in patients with breast cancer in this environment.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
Background:Different trends have been reported on the age prevalence of HPV in Africa. The result... more Background:Different trends have been reported on the age prevalence of HPV in Africa. The results of some studies showed there was a high peak of HPV prevalence among younger women, which decreased with age, but among older women the prevalence either decreased, reached a plateau or increased. There is scare data on the relation between persistent HPV infection and age. Methods:Women presenting at cervical cancer screening programs in Abuja, Nigeria between 2012 and 2014 were enrolled, data on demographic characteristics, risk factors of HPV infection and samples of cervical exfoliated cells were collected at baseline, 6 and 12 months follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as positive results on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and the risk of HPV infections. Results:We enrolled 1020 women, their mean (SD) age was 37 (8), the prevalence of any HPV and persistent HPV was 53% and 17%, respectively. The women were dichotomized into age groups, young: 18–35 (42%) and older: >35 years (58%). The prevalence of any HPV infection was 47% among the young women and 53% among the older women, P-value = 0.004. The prevalence of persistent HPV infection was 44% among the young women and 56% among the older women, P-value = 0.67. The multivariate odds ratio (OR) and 95% confidence interval (95% CI) among the young women was 1.30 (95% CI: 0.85 to 1.16, P-value 0.06) for any HPV infection and 0.84 (95% CI: 0.58 to 1.21, P-value 0.35) for persistent HPV infection, compared to older women. Conclusions:These results suggest that the pattern of HPV persistence among young and older women is not different. We will present the results on type specific HPV infection stratified by age, at the upcoming meeting.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
Background:Cervical cancer incidence has remained stable in HIV+ women but the prevalence, persis... more Background:Cervical cancer incidence has remained stable in HIV+ women but the prevalence, persistence and multiplicity of HPV infection appears different comparing HIV+ to HIV− women. We examined the association between HIV, prevalent and persistent HPV infections among women in a prospective cohort in Nigeria. Methods:Women were recruited from cervical cancer screening programs in Abuja, Nigeria between 2012 and 2014, data on demographic characteristics, risk factors of HPV infection and samples of cervical exfoliated cells were collected at baseline, 6 and 12 months follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as positive results on 2 consecutive DEIA tests. Logistic regression models were used to estimate the association between HIV and the risk of HPV infections. Results:Among the 1020 women enrolled, the mean age (±SD) was 37 (8), 44% and 56% were HIV+ and HIV-, respectively. The prevalence of any HPV infection was 53% (58% among HIV+; 42% among HIV−, P-value <0.001); the prevalence of persistent HPV infection was 17% (78% among HIV+; 22% among HIV−, P-value <0.001). The multivariate relative risk and 95% confidence interval (95% CI) was 3.22 (95% CI: 2.40 to 4.32, P-value <0.001) for any HPV infection and 5.52 (95% CI: 3.61 to 8.44, P-value <0.001) for persistent HPV infection, comparing HIV+ to HIV− women, adjusted for variables that reached statistical significance in univariate analyses: age, age at sexual initiation, number of lifetime sexual partners, marital status and level of education. Conclusions:HIV infection is associated with increased risk of any HPV and persistent HPV infections. Previously, we reported that the most prevalent high risk HPV types were HPV35 (8.7%) and HPV56 (7.4%) among HIV+ women, and HPV52 and HPV68 (2.8%, each) among HIV- women, from a subset of this population. We will present the results of the specific HPV types in the entire study population, at the forthcoming conference.
The microbiota plays an important role in prevention of colonization of the vagina by pathogenic ... more The microbiota plays an important role in prevention of colonization of the vagina by pathogenic organisms such as HIV, Herpes simplex virus and N. gonorrhea. Given the role of persistent high risk HPV (hrHPV) infection of the cervix as a necessary but not sufficient cause of cervical, we hypothesized that in addition to other risk factors, specific community types of vaginal microbiota may be cofactors in the etiology of cervical cancer and pre-cancer (CIN2+). We enrolled HIV+ and HIV- women who presented to our cervical cancer screening program at the National Hospital, Abuja and the University of Abuja Teaching Hospital, Abuja, Nigeria between April and August 2012 into this study. Using a nurse administered questionnaire, we collected information on demographics and risk factors of cervical cancer. Without cleaning the introitus, we collected mid-vaginal samples and cervical exfoliated cells from all participants. We characterized the vaginal microbiota from the mid-vaginal samp...
The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomav... more The vaginal microbiota is thought to play a role in modulating risk of high-risk human papillomavirus (hrHPV) infection. We examined the relationship between the vaginal microbiota and persistent hrHPV infection in HIV-negative and HIV-positive women. We used 16S-rRNA sequencing to characterize the vaginal microbiota of two serial samples taken six months apart from 211 Nigerian women (67%, 142/211 HIV-positive and 33%, 69/211 HIV-negative) and evaluated the association between the vaginal microbiota and persistent hrHPV infection using generalized estimating equation logistic regression models and linear discriminant analysis effect size (LEfSe) algorithm to identify phylotypic biomarkers of persistent hrHPV infection. The high diversity microbiota, Community State Type IV-B, was the most prevalent in both HIV-negative (38% at baseline, 30% at the follow-up visit) and HIV-positive (27% at baseline, 35% at the follow-up visit) women. The relationship between the vaginal microbiota a...
Purpose There is a dearth of data on clearance of cervical human papillomavirus (HPV) infection a... more Purpose There is a dearth of data on clearance of cervical human papillomavirus (HPV) infection among women in West Africa. We examined the clearance of low-risk (lr) and high-risk (hr) cervical HPV infections, and the factors associated with these measures in HIV-negative and HIV-positive women. Methods We studied 630 Nigerian women involved in a study of HPV infection using short polymerase chain reaction fragment-10 assay and line probe assay-25. Research nurses used a cervical brush to collect samples of exfoliated cervical cells from all the study participants. Cox proportional hazards models were used to estimate associations between HIV and HPV infections. Results The mean age of the study participants was 38 (standard deviation, ± 8) years; 51% were HIV positive. The rate of clearing any HPV infection was 2.0% per month among all women in the study population, 2.5% per month among HIV-negative women, and 1.6% per month, among HIV-positive women. The clearance rate per 1,000 ...
The prevalence, persistence, and multiplicity of human papillomavirus (HPV) infection appears dif... more The prevalence, persistence, and multiplicity of human papillomavirus (HPV) infection appears different comparing HIV-positive to HIV-negative women. In this study, we examined prevalent, persistent, and multiple low- and high-risk cervical HPV infections in HIV-negative and HIV-positive women. We studied 1,020 women involved in a study of HPV infection using SPF25/LiPA10. Two study visits were scheduled, at enrollment and 6 months afterward. At each study visit, research nurses used a cervical brush to collect samples of exfoliated cervical cells from the cervical os, from all the study participants. Exact logistic regression models were used to estimate associations between HIV and HPV infections. The mean (SD) age of the study participants was 38 (8) years, 56% were HIV-negative and 44% were HIV-positive. Among HIV-negative women at baseline, single low-risk HPV (lrHPV) infections occurred in 12%; multiple lrHPV in 2%; single high-risk human papillomavirus (hrHPV) infections in 9...
64 Background: The incidence, prevalence, persistence, and multiplicity of high-risk HPV infectio... more 64 Background: The incidence, prevalence, persistence, and multiplicity of high-risk HPV infection is different between HIV positive and HIV negative women. We examined the association between HIV, prevalent HPV, and persistent HPV infections among women in a prospective cohort in Nigeria. Methods: We enrolled women presenting at cervical cancer screening programs in Abuja, Nigeria, between 2012 and 2014 and collected information on their demographic characteristics, risk factors of HPV infection, and cervical exfoliated cells samples at baseline, 6 month and 12 month follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as a positive result on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and risk of HPV infection. Results: Among the 1,020 women enrolled, the mean age (±SD) was 37(8), and 44% and 56% were HIV+ and HIV-, resp...
65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown a... more 65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown about the prevalence and pathogenicity of human papillomavirus (HPV) types and the mechanism of disease, and there is a need for new biomarkers for screening programs. Methods: ACCME is a multicenter prospective cohort study of host germline, somatic and HPV genomics and epigenomics, and vaginal microenvironment; and their association with cervical cancer in 10,000 HIV negative women in Nigeria. Data on demographic, lifestyle, medical history, serum, germline DNA, HPV genotype, and vaginal pH are collected at baseline and during follow up visits every 6 months. Samples of exfoliated cervical cells are analyzed for high risk HPV with Roche LINEAR ARRAY and vaginal bacterial composition and abundance are characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on a Illumina MiSeq platform. Colposcopies and biopsies are conducted on participants with clinical lesions and tho...
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Papers by Ayotunde Famooto