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Dr. Admire T. Chikandiwa

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chikDr Admire Takuranenhamo Chikandiwa, MB ChB (UZ), MPH (UWC), Dip in HIV Man (CMSA) is an upcoming epidemiologist who is employed at Wits Reproductive and HIV Research Institute (Wits RHI), University of the Witwatersrand (Wits). He also holds joint appointment with Wits University as a researcher. He has six years’ experience working in the public health environment. He has worked on a number of programs in Zimbabwe, Lesotho, Swaziland and presently South Africa. Currently he is working on the Human Papillomavirus (HPV) Research Programme where he is actively involved in the design, implementation and analysis of two research studies  (HIM and HIM) evaluating the effects of HIV infection and treatment on HPV disease progression in men and women in South Africa. He has a research interest in infectious diseases, particularly sexually transmitted diseases. He is in the early stages of PhD studies. As a student he received several prizes including: Best overall MPH 2010 student with Cum Laude, Distinctions in: Health Systems Research, Advanced Epidemiology and Biostatistics, Clinical Pharmacology, Anatomy, Biochemistry, University Book Prize and University of Zimbabwe – University of Sassari (Italy) Exchange Scholarship.

Abstract Title

Epidemiology Of Low Risk Human Papillomavirus Infection (LR-HPV) And Genital Warts In HIV Positive Women In Africa:

Results From The HARP Study.

Abstract text (max 2500 characters incl spaces):

Background: We assessed the prevalence, genotype distribution and risk factors for low-risk (LR) HPV, and the associations with

anogenital warts (AGW) among HIV-positive African women enrolled in the HPV African Research Partnership (HARP) study in

South Africa (SA) and Burkina Faso (BF). Methods: The study enrolled non-pregnant HIV-positive women aged 25-50 years.

Stratified sampling was used, with 2/3 women on ART. Socio-demographic data was collected in an interviewer-administered

questionnaire. Anogenital warts were assessed during pelvic examination. Cervical HPV genotyping was performed using InnoLipa.

Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) were

detected on cervical swabs using Sacace PCRs in BF, and multiplex PCR followed by confirmatory APTIMA® PCR for NG/CT

and Sacace RT-PCR for TV/MG in SA. Vaginal smears were Gram-stained and examined for Candida and bacterial vaginosis

(BV) using Nugent’s score. Associations between infection or AGW and selected risk factors were estimated by logistic regression.

Results: 625 and 632 women were enrolled in SA and BF respectively. The distribution of CD4+ counts (cells/ìL) was similar in

both sites: 32.2% with CD4+ < 350 and 10% with CD4+<200. Overall, 6.9% of women had anogenital warts detected; 5.8% in

SA and 8.0% in BF. Overall, 58.3%, 52.2%, 43.9% and 41.8% of women with CD4+ <200, 200-350, 351-499 and 500+ were

positive for LR-HPV. The most common genotypes in SA were HPV 66 (13.2%), 53 (10.6%) and 44 (11.9%), and in BF were

HPV 53 (10.0%), HPV 66 (7.4%) and 44 (8.0%). The prevalence of vaccine preventable types HPV 6/11 was 10.1% in SA and

7.2% in BF. The prevalence of multiple LR-HPV types was higher in SA (24.3%) compared to BF (13.9%) (p < 0.001). The

proportion of women with LR-HPV who also had HR-HPV was 19.4% in SA, and 35.6% in BF (p < 0.001). Prevalence of LRHPV

genotypes without high-risk types was 9.8% among women in SA and 16.7% in BF. In SA, the prevalence of multiple LRHPV

infections decreased with an increase in the baseline CD4+ count stratum <200 (67.9%), 200-350 (57.8%), 351-499

(47.3%) and 500+ (50.7%) (p for trend = 0.041). A similar association was observed for women in BF: <200 (50.7%), 200-350

(50.0%), 351-499 (40.4%) and 500+ (33.2%) (p for trend = 0.061). LR-HPV infection was associated with AGW in SA [aOR

2.03, 95% CI: 0.97-4.23] and BF [aOR 2.81, 95% CI: 1.02-7.77]. The association was stronger with analysis limited to prevalent

HPV 6/11 infection: SA [aOR 12.1, 95% CI: 1.10-124] and BF [aOR 11.8, 95% CI: 1.03-135]. There was no association

between LR-HPV infections and smoking history, pregnancy history, STI co-infections, ART status and plasma viral load.

Conclusions: The prevalence of AGW in this population is similar to other HIV positive populations, and higher than in HIV negative

populations. While HPV 66 and HPV 53 were the most dominant types in SA and BF respectively, AGW were strongly associated

with HPV 6/11 supporting the importance of using existing vaccines for the prevention of AGW in HIV-positive women.

References

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Track Descriptors

300 Track C: Basic HIV Epidemiology – C1. Natural history and Molecular epidemiology of HIV

Young Investigator Award

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Authors of the Abstract

Chikandiwa, A., ADMIRE, Wits RHI, University of the Witwatersrand, South Africa, South Africa (Presenting); Delany-Moretlwe,

S., Sinead, Wits RHI, Univeristy of the Witwatersrand, South Africa, South Africa; Sawadogo, B., Bernard, Centre de Recherche

International pour la Sante, Universite de Ouagadougou, Burkina Faso; Gibson, L., Lorna, London School of Hygiene and Tropical

Medicine, United Kingdom; Ngou, J., Jean, University of Montpellier 1 & INSERM U1058, France; Kelly, H., Helen, London

School of Hygiene and Tropical Medicine, United Kingdom; Didelot, M.N., M, University of Montpellier 1 & INSERM U1058,

France; Meda, N., Nicolas, Centre de Recherche International pour la Sante, Universite de Ouagadougou, Burkina Faso; Wiess,

H., Helen, London School of Hygiene and Tropical Medicine, United Kingdom; Segondy, M., Michel, University of Montpellier 1

& INSERM U1058, France; Mayaud, P., Philippe, Wits RHI and London School of Hygiene and Tropical Medicine, United

Kingdom

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