The demographics of women with multizonal anogenital HPV disease:a retrospective cohort study in Cape Town, South Africa

Abstract

Objectives: Multizonal human papillomavirus (HPV)-associated disease refers to HPV involvement at different anatomical sites of the lower genital tract. This study aimed to document the prevalence of multizonal HPV-associated disease (multizonal intraepithelial neoplasia [MUZIN]) in women attending the colposcopy clinic at Groote Schuur Hospital in 2018, and describe the demographics of this population.

Methods: We conducted a retrospective review of all new women at the colposcopy clinic in 2018. Evidence of HPV disease was based on clinical findings and pathology reports. HPV deoxyribonucleic acid (DNA) testing was not routinely done at our centre during the study period. We specifically aimed to calculate the prevalence of multizonal HPV-associated disease and identify risk factors.

Results: In 2018, 653 women attended the clinic, of whom 104 (16%) had evidence of MUZIN. Of the entire cohort, 320 (49%) were human immunodeficiency virus (HIV)-positive. This contrasts with the 78/104 women (75%) with multizonal disease who were HIV-positive (p < 0.001). Tuberculosis was also a significant association among MUZIN patients and all patients (p = 0.004). In the MUZIN cohort, most women were on antiretroviral treatment, and 89% were virologically suppressed. In South Africa, CD4 counts are taken at diagnosis, and 75.6% of women had initiated treatment when their CD4 counts were < 500.

Conclusion: This study suggests that MUZIN may be related to an inadequate or non-functional immune response, although prospective studies are required to confirm this hypothesis.