Background:  HIV is a known risk factor for human papillomavirus (HPV) prevalence and persistence. The objectives of this study were to obtain baseline HPV genotype prevalence in HIV⁺ and HIV^– women in Kampala, Uganda and to determine which genotypes are associated with cervical pathology in this population.

Methods:  We recruited 200 women aged 18 to 30 years at 4- to 12-weeks post-partum at Mulago Hospital, who were counseled and consented and underwent rapid HIV testing and a pelvic exam. Liquid-based cervical cytology samples were collected and processed using the Maksem low-cost manual technique. A Digene cervical sampler was used to collect specimens for genotyping by Roche Diagnostics HPV Linear Array. The Fisher’s exact 2-sided test and the Wilcoxon rank-sum test (with continuity correction) were used to assess the statistical significance of differences observed between proportions and medians, respectively.

Results:  HIV prevalence was 19%, and HPV prevalence was 65%. The most common high-risk HPV genotypes were 16 (9%), 33 (9%), 35 (6.5%), 45 (6.5%), and 58 (6%); the most common low-risk genotypes were 62 (22%), 61 (11%), 81 (11%), 70 (10%), and 53 (10%). The prevalence of HPV 6, 11, and 18 was 2.5%, 1%, and 4%, respectively. There was no significant difference between the presence of HPV 16 or HPV 18 and HIV status (positive vs negative) (13.9% vs 7.3%, p = 0.20 and 3.7% vs 5.6%, p = 0.64, respectively), but HIV⁺ subjects were more likely to be infected by other high- and low-risk HPV genotypes than HIV^– women (72.2% vs 40.9%, p <0.001 and 63.9% vs 36.6%, p = 0.0046, respectively). HIV⁺ women were also infected with a greater median number and range of HPV genotypes when compared to HIV^– women (median of 2, range 0 to 8 vs median of 1, range 0 to 6, p <0.001). Women with HIV were significantly more likely to have an abnormal Pap smear than those who were HIV^– (43% vs 11%, p <0.001). HPV prevalence was 58% in women with normal cytology and 97% in women with abnormal cytology. Of note, HPV 16 and 18 prevalence in women with normal cytology was 9.9% and in women with abnormal cytology was 28%.

Conclusions:  Our results show that while HPV types 16 and 18 may be seen in association with cervical pathology, preventative, or therapeutic vaccines will need to target a broad-spectrum of HPV genotypes to effectively combat cervical disease in this population.