TEHSA: The Epidemiology of Human Papillomavirus and Associated Disease in HIV Positive Men in SA

TEHSA: The Epidemiology of Human Papillomavirus and Associated Disease in HIV Positive Men in SA

Human papillomavirus (HPV) is the most common STI worldwide. It is associated with significant morbidity and mortality. More data is needed on the natural history of HPV infection in the context of high HIV prevalence to inform appropriate prevention and control strategies.

Specific Objectives
1. Determine the prevalence of anogenital and oropharyngeal HPV infection, genotype distribution, and associations with anogenital disease, according to HIV-related factors (e.g. plasma viral load, CD4+ counts) and exposure to antiretroviral treatment (ART).
a. Within this, compare the performance of oral swabs to oral rinses in detecting oral HPV infection in an urban cohort of HIV positive men in SA.
2. Determine the incidence, persistence, and clearance of type-specific anogenital and oropharyngeal HPV infection and anal cytological lesions over 18 months and the effects of HIV-related factors and ART on these outcomes.
b. Within this, determine the clinical relevance of HPV viral load to predict persistence of infection and cytological abnormalities at follow-up and effects of HIV-related factors on these outcomes.
3. Describe and report the epidemiology of anogenital and oropharyngeal cancer patterns and trends in men including incidence and mortality rates and differences by ethnicity in SA between 1994 and 2010. Furthermore, explored the influence of HIV status on epidemiology of these cancers.

Study Design
Data from two sources are being used:
Study 1 will provide data to address objectives (1) and (2). Study 1 involves further analysis of data collected during the prospective, observational cohort study of HIV positive men conducted during
the period 2012-2014 (HIM-SA). Study design and population: for objective (ii), cross-sectional data collected at the enrolment visit for 304 consenting men who were at least 18 years of age, sexually active, and HIV positive has been analysed. For objective 3, study design and population: longitudinal data collected from 287 men who attended at least one follow up visit at either month 6, 12 and/or 18 is being analysed.
Study 2 addresses research objective (3). Study design and population: Surveillance data sourced from South African National Cancer Registry (NCR) pathology-based reports and mortality from Statistics South Africa (Stats SA) for 1994-2013, are being used for this analysis.

Study Site
Ward 21 Clinical Research Site, Hillbrow Health Precinct, Johannesburg, South Africa
Study Duration
01/06/2017 – 31/06/2020 (3 years)

Investigators
Dr Admire Chikandiwa, Wits RHI, PI
Prof Sinead Delany-Moretlwe, Wits RHI, Co-Investigator and PhD Supervisor

Other Partners & Collaborators
Prof Pedro Pisa, formerly Wits RHI, Co-Investigator and PhD Supervisor
Dr Etienne Muller, National Institute of Communicable Diseases, South Africa
Dr Pamela Michelow, National Health Laboratory Services, South Africa
Prof Philippe Mayaud, London School of Hygiene and Tropical Medicine, London
Dr Helena Faust, Karolinska Institute, Stockholm, Sweden
Prof Joakim Dilner, Karolinska Institute, Stockholm, Sweden
Dr Catherine Tamalet, Timone, University Hospital Marseille, France, France

Sponsors/Donors
European Developing Country Clinical Trial Partnership (EDCTP)-TMA CDF 1032
Cancer Association of South Africa (CANSA)

Publications to date

  1. Chikandiwa, A, Chimoyi, L, Pisa, P.T, Chersich, M.F, Muller, E.E, Michelow, P, Mayaud, P and Delany-Moretlwe, S. (2017). Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: Baseline findings from a cohort study. BMC Public Health, 17(Suppl 3): 425. DOI 10.1186/s12889-017-4354-0
  2. Chikandiwa, A, Pisa, P.T, Chersich, M.F, Muller, E.., Michelow, P, Mayaud, P and Delany-Moretlwe, S. (2018). Oropharyngeal HPV infection: prevalence and sampling methods among HIV-infected men in South Africa. International Journal of STD & AIDS. DOI : 10.1177/0956462418755882. [Epub ahead of print],
  3. Chikandiwa, A, Pisa P.T, Singh E, Sengayi, M and Delany-Moretlwe S. HPV-related cancers other than cervical in South Africa: patterns and trends from 1994 to 2013. (2019). Cancer Epidemiology, 58: 121-129. DOI: 10.1016/j.canep.2018.12.004
  4. Chikandiwa, A, Pisa, P.T, Tamalet, C, Muller E.F., Michelow, P, Chersich, M.F, Mayaud, P and Sinead Delany-Moretlwe, S. Incidence, persistence and clearance of genital HPV infection and anogenital warts among men living with HIV/AIDS. (2019) Sex Transm Dis. DOI: 10.1097/OLQ.0000000000000979. [Epub ahead of print]
  5. Chikandiwa, A, Faust, H., Mayaud, P., Dillner, J and Delany-Moretlwe S. HPV seroprevalence and seroconversion among HIV-positive men: Cohort study in South Africa. (2020), JAIDS. 84(2): 141-148.
  6. Kelly, H, Chikandiwa, A, De Sanjose, S, Palefsky, J, and Mayaud P. The effect of antiretroviral therapy on anal high-risk human papillomavirus, intraepithelial neoplasia and cancer among people living with HIV: a systematic review and meta-analysis. (2020). Lancet HIV.7(4): e262-e278.
  7. Chikandiwa, A, Pisa P.T, Tamalet C, Muller E,F, Michelow P, Chersich M.F, Mayaud, P and Sinead Delany-Moretlwe, S. Prevalent, persistent anal HPV infection and squamous intraepithelial lesions: Findings from a cohort of men living with HIV/AIDS in South Africa. (2019). PloS One, 14 (12): e0225571

Conference presentations to date

  1. Chikandiwa, A, Chimoyi, L., Pisa, P.T., Chersich, M.F., Muller, E.E., Michelow, P., Mayaud, P and Delany-Moretlwe, S. Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: Baseline findings from a cohort study. 31st International Papillomavirus Conference, Cape Town, 28 February-5 March 2017.
  2. Chikandiwa, A, Pisa, P.T, Tamalet, C, Kularatne, R, Michelow, P, Chersich, M.F, Mayaud, P and Sinead Delany-Moretlwe, S. Factors associated with anogenital HPV infection and disease prevalence, incidence, persistence: a prospective cohort study. CANSA Research in Action Conference. Pretoria, South Africa. 3-5 July 2018
  3. Chikandiwa, A, Pisa, P.T, Tamalet, C, Kularatne, R, Michelow, P, Chersich, M.F, Mayaud, P and Sinead Delany-Moretlwe, S. Natural history of anogenital HPV infection and related disease among HIV-positive men: Findings from a Cohort Study in South Africa. 22 International AIDS Conference. Amsterdam, the Netherlands. 21-27 July 2018.
  4. Chikandiwa, A, Pisa, P.T, Tamalet, C, Kularatne, R, Michelow, P, Chersich, M.F, Mayaud, P and Sinead Delany-Moretlwe, S. Natural history of anogenital HPV infection and related disease among HIV-positive men: Findings from a Cohort Study in South Africa. Wits Faculty of Health Research Day. Johannesburg, South Africa. 6 September 2018.
  5. De Sanjose, S, Kelly H, Chikandiwa A, Palefsky, Joel, Mayaud, P. The effect of antiretroviral therapy on anal high-risk human papillomavirus, intraepithelial neoplasia and cancer among people living with HIV: a systematic review and meta-analysis. 32nd International Papillomavirus Conference, Sydney, Australia, 2-6 October 2018.
  6. Chikandiwa A, Faust H, Mayaud P, Dillner J, Delany-Moretlwe S. HPV seroprevalence and seroconversion among HIV-positive men: Cohort study in South Africa. STI & HIV World Congress, Vancouver, Canada, 14-17, July 2019.
  7. Chikandiwa A. HPV pathogenesis, microbiology, and immunology. MSc Vaccinology Lecture, University of the Witwatersrand, Johannesburg, South Africa, 22 May 2020.

Overall Study contact and date
Dr Admire Chikandiwa (achikandiwa@wrhi.ac.za)

Latest Update: 7 July 2020

For more on TEHSA please email rhicomms@wrhi.ac.za