BACKGROUND: Persistent infection with high-risk types of human papillomavirus (HPV) is the pre-eminent factor driving the development of cervical cancer. There are large gaps in knowledge about both the role of pregnancy in the natural history of HPV infection, and the impact of HPV on pregnancy outcomes. METHODS: This single-site prospective cohort sub-study, nested within an international multi-site randomized controlled trial, assessed prevalence, incident cases and persistence of type-specific HPV infection, and the association between persistence of high-risk HPV infection with pregnancy outcomes among HIV-infected pregnant women in Kenya, including HIV transmission to infants. Type-specific HPV was assessed using a line probe assay in pregnancy and again at 3 months after delivery. HIV status of children was determined using PCR at 6 weeks. RESULTS: In total, 84.1% of women (206/245) had a high-risk HPV infection at enrolment. Three quarters of these infections persisted postpartum (157/206). Persistence of HPV16 and/or HPV18 types was observed in over half (53.4%; 39/73) of women with this infection at enrolment. Almost two-thirds had an incident high-risk HPV infection postpartum, which was not present in pregnancy (62.5%), most commonly HPV52 (19.0%). After adjustments, no association was detected between persistent high-risk HPV and preterm birth. All mothers of the seven cases of infant HIV infection had persistent HR-HPV infection (P=0.044). CONCLUSIONS: High levels of high-risk HPV infection and type-specific persistence were documented, heightening the urgency of mass role out of HPV vaccination. The association between HPV persistence and HIV transmission is a novel finding, warranting further study.
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