Browsing by Author "Mwanahamuntu, Mulindi H."

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Cervical intraepithelial neoplasia progression and regression among women living with HIV in Zambia
(2025-10-16) Andoh, John; Taghavi, Katayoun; Moono, Misinzo; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Low, Nicola; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia. Methods: Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression. Results: Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment. Conclusions: Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
Human papillomavirus detection in liquid-based cytology and cervical histology samples among women living with human immunodeficiency virus in Zambia
(2026-08-11) Taghavi, Katayoun; Moono, Misinzo; Villalobos, Nathalie V. F.; Andoh, John; Glass, Allison; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervicovaginal human papillomavirus (HPV) prevalence is high among women living with human immunodeficiency virus (WLHIV), but not all HPV genotypes detected in liquid-based cytology (LBC) may be present in cervical tissue. We explored HPV genotype concordance in paired LBC and histology samples among WLHIV in Zambia. Methods: WLHIV aged 18-65 years who were enrolled in a cervical screening test accuracy study were invited for follow-up after 30-36 months. LBC samples and two or more cervical biopsies were collected and tested for 28 HPV genotypes (Anyplex II/Allplex HPV28, Seegene, South Korea). HPV prevalence and genotype-specific agreement were assessed using Cohen's kappa. Results: From April 2022 to May 2023, 242 WLHIV (22 with high-grade squamous intraepithelial lesions) had valid paired HPV results. The prevalence of any HPV was similar on LBC (39%) and histology (34%). Multiple-type infections were more common on LBC (18%) than on histology (10%). HPV 16 was the most frequent genotype: 9% (n = 22) on LBC, and 15% (n = 36) on histology. Agreement for any high-risk HPV genotype was 66.1% (kappa = 0.27). Conclusions: Among Zambian WLHIV with mostly low-grade cervical lesions, LBC showed more multiple-type HPV infections and limited agreement with histology samples, possibly reflecting transient infections detected by LBC. The frequent detection of HPV 16 in histology samples but not in LBC warrants further investigation.
The burden of cervical pre-cancer and cancer in HIV positive women in Zambia: a modeling study.
(2015-Jul-24) Bateman, Allen C.; Katundu, Katundu; Mwanahamuntu, Mulindi H.; Kapambwe, Sharon; Sahasrabuddhe, Vikrant V.; Hicks, Michael L.; Chi, Benjamin H.; Stringer, Jeffrey S.; Parham, Groesbeck P.; Chibwesha, Carla J.
BACKGROUND: HIV infection is associated with a higher incidence of precancerous cervical lesions and their progression to invasive cervical cancer (ICC). Zambia is a global epicenter of HIV and ICC, yet the overall burden of cervical pre-cancer [cervical intraepithelial neoplasia 3 (CIN3)] and ICC among its HIV positive adult female population is unknown. The objective of this study was to determine the burden of cervical disease among HIV positive women in Zambia by estimating the number with CIN3 and ICC. METHODS: We conducted a cross-sectional study among 309 HIV positive women attending screening in Lusaka (Zambia's most populated province) to measure the cervical disease burden by visual inspection with acetic acid enhanced by digital cervicography (DC), cytology, and histology. We then used estimates of the prevalence of CIN3 and ICC from the cross-sectional study and Spectrum model-based estimates for HIV infection among Zambian women to estimate the burden of CIN3 and ICC among HIV positive women nationally. RESULTS: Over half (52 %) of the study participants screened positive by DC, while 45 % had cytologic evidence of high grade squamous intraepithelial lesions (SIL) or worse. Histopathologic evaluation revealed that 20 % of women had evidence of CIN2 or worse, 11 % had CIN3 or worse, and 2 % had ICC. Using the Spectrum model, we therefore estimate that 34,051 HIV positive women in Zambia have CIN3 and 7,297 have ICC. CONCLUSIONS: The DC, cytology, and histology results revealed a large cervical disease burden in this previously unscreened HIV positive population. This very large burden indicates that continued scale-up of cervical cancer screening and treatment is urgently needed.