Central African Journal of Medicine

Prevalence and genotype distribution of high risk human papillomavirus among HIV infected and uninfected women in Harare, Zimbabwe

N Zia — 2023-09-05

Introduction: High-risk Human Papilloma viruses (hr-HPVs) are one of the most important causative agents of cervical cancer. Genotype testing for hr-HPV DNA is a valuable cervical cancer screening tool. It is used for the determination of HPV prevalence and subtype distribution, which are useful in evaluating the impact of HPV vaccines and possibly policy formulation for national cervical cancer vaccination programs.

Objective: This study aimed to determine the prevalence and distribution of hr-HPV genotypes and their association with cytology amongst HIV-positive and negative women in Harare, Zimbabwe.

Design and Setting: A cross-sectional study was conducted between 2017 and 2019 among HIV-infected and uninfected Zimbabwean women who presented for cervical cancer screening at the Family Planning Clinic at Parirenyatwa Hospital, Harare. Nurses obtained the cervical samples and Liquid-Based Cytology and hr-HPV DNA testing were performed using automated BD SurePathTM liquid based Pap test and Cepheid GeneXpert (Sunnyvale, California) respectively.

Subjects: Two hundred and twenty-eight (228) women were enrolled in to the study and47.8% were HIV-infected. The participants were selected randomly as they walked into the clinic and were not necessarily indisposed. The median age was 40 years and 39 years for HIV-infected and HIV-uninfected participants, respectively.

Results: The overall prevalence of hr-HPV was 41.1% with higher prevalence observed in HIV-infected (57.9%) when compared to HIV-uninfected women (25.6%), p=<0.001. Multiple hr-HPV infections were higher in HIV-infected (16.0%) than HIV-uninfected (4.3%) women, p=<0.001. The most common types were hr-HPV 16 and hr-HPV 18/45, with each exclusively observed in 12.0.9% and 15.2% of infections respectively. About48.9% of women infected by hr-HPV “other” had at least one type of hr-HPV type not covered by the bivalent vaccine. This category included 64.4% of HIV-infected and 35.5% of HIV-uninfected women. The prevalence of hr-HPV increased with the severity of the cytological lesions. In HIV-infected women, the hr-HPV prevalence was 44.8% in ASCUS, 74.1% in LSIL and 84.6% in HSIL/ASC-H, while in HIV-uninfected women it was 15.4% in ASCUS, 37.9 % in LSIL and 55.0% in HSIL/ASC-H (p=<0.001).

Conclusion: In both HIV infected and uninfected groups, HPV infection peaked in middle-aged women (30 to 40 years). However, hr-HPV infection increased with age in HIV-infectedwomen and decreased with age in HIV-uninfected women. The hr-HPV prevalence was two times higher among HIV-infected than uninfected women with the prevalence increasing with severity of cytological lesions in both HIV-infected and uninfected women. Infection with multiple hr-HPV types and a strong association between abnormal cytology and HIV infection was observed. Other hr-HPV types besides types 16 and 18/45 were also prevalent in significant proportions. Further investigation is recommended to ascertain the cross protection of the cervical cancer vaccine available in Zimbabwe against the high-risk types other than 16 and 18/45. We also recommend a more systematic approach to hr-HPV data collection for a successful cervical cancer prevention program.

Does glucose still have a role in the monitoring and management of diabetes?

TN Mujuru — 2023-09-05

Introduction: Since time immemorial glucose has been used as front line biomarker in the management of diabetes. Glucose has probably the highest number analytical methods developed in an attempt to optimally monitor and manage diabetes. Most of these analytical methods are in-cooperated in Point-of-Care Testing (POCT) devices and central laboratory analysers. Therefore, most healthcare facilities in South Africa depend on the results of random glucose from glucometer POCT devices. Since the introduction of glycated Haemoglobin (HbA1c), which is now accepted as a better diagnostic and monitoring biomarker for diabetes, the aim of the study was to determine if glucose measurement still has a role in the monitoring and management of diabetes.

Design: A comparative study between glucose and HbA1c was conducted at an academic hospital diabetes outpatients' clinic. Based on the clinic's protocol, patients had random capillary finger prick blood for both glucose and HbA1c tested on site by a medical laboratory scientist before consultation with the attending clinicians.

Results: Ninety one percent of the 171 patients had abnormal HbA1c results and 41.5% (70 of the171) patients had abnormal random blood glucose levels. Bland-Altman scatter plot analysis had a mean glucose concentration of 1.984, with limits of acceptance of -5.527 and 9.495. An agreement of 42.7% was calculated. Spearman's correlation was also performed and revealed a statistically moderate correlation between random capillary glucose and HbA1c (r = 0.60, p=< 0.001).

Conclusion: There is a low-to-moderate correlation between HbA1c and random glucose levels. Therefore, the age old measurement of glucose has lost its central role in the management and monitoring of patients with diabetes.

Delayed puberty in HIV positive adolescents attending an opportunistic disease clinic in Harare, Zimbabwe

T Zaranyika — 2023-09-05

Introduction: Puberty is a complex biological process involving physical and hormonal changes in which the body transitions to sexual maturity.

Objective: The objective of the study was to determine the magnitude of delayed puberty in older children at an opportunistic disease clinic in Harare, Zimbabwe.

Design: A retrospective data review nested within the clinical outcomes in children and adolescents with chronic HIV in a Zimbabwe Study.

Setting: The opportunistic disease clinic at Parirenyatwa Group of Hospitals, Harare, Zimbabwe.

Subjects: The sample size was 279 adolescents.

Inclusion Criteria: HIV positive boys 14 years and older and HIV positive girls 13 years and older. Children with Tanner stage assessment.

Main Outcome Measure: The prevalence of delayed puberty was the main outcome measure.

Results: Two hundred and seventy nine (279) adolescents between 13 and 19 years were enrolled. One hundred and sixty, (57.4%) were female and 119 (42.7%) were male. Mean age at enrolment was 16.1 +/-1.9 years. Median CD4 count was 446 (IQR 281- 652) cells/mm3. A total of 96 (54.2%) had undetectable viral load at enrolment. Delayed puberty in males 6/160 (3.75%). Delayed puberty in females 4/119 (3.36%).

Conclusion: The prevalence of delayed puberty was 3.75% in males and 3.36% in females.

Letters to the Editor: Structural birth defects in new born babies admitted to Mbuya Nehanda Maternity Hospital Neonatal Unit, Parirenyatwa Group of Hospitals, Harare, Zimbabwe

M Dhoro — 2023-09-05

No abstract.