High risk HPV among HIV positive women with normal and abnormal cervical cytology in Bahir Dar, north west Ethiopia

Abstract

Cervical cancer is a malignant tumor that arises from the cells of the uterine cervix, primarily caused by persistent infection with human papillomavirus (HPV). Women living with HIV are at a heightened risk of infection with high-risk HPV types. This study aimed to determine the prevalence and type-specific distribution of HPV among HIV-positive women with cervical cytologic abnormalities in Bahir Dar, northwestern Ethiopia. A facility-based cross-sectional study was conducted among HIV-positive women in this region between January and March 2025. A total of 344 women were enrolled. Of these, 171 (49.7%) had a high-risk HPV (HR-HPV) infection. The type-specific distribution among the positive cases was as follows: HPV16, 37 (21.6%); HPV18, 15 (8.8%); HPV16 with other types, 24 (14.0%); HPV18 with other types, 7 (4.1%); both HPV16 and HPV18, 6 (3.5%); and other high-risk types, 82 (47.9%). Cytological analysis revealed that 81 women (23.55%) had abnormalities, while 263 (76.45%) had normal results. Among the abnormal cases, the findings were: 26 (32.1%) ASC-US, 22 (27.2%) LSIL, 14 (17.3%) ASC-H, 9 (11.1%) LSIL-H, and 10 (12.3%) HSIL. The study also found that HIV-positive women aged 31 and older had significantly higher odds of HR-HPV infection compared to younger women, with the peak risk observed in the 41–50 age group. Additional risk factors included higher parity, an early sexual debut, and having multiple sexual partners. Given the high prevalence of HR-HPV and its strong association with abnormal cytology, targeted preventive measures including enhanced screening, vaccination, and patient education are crucial for HIV-positive women, particularly in low-resource settings like northwestern Ethiopia.

Introduction

A malignant growth called cervical cancer arises from cells in the uterine cervix¹. Annually, it accounts for 600 000 new cases and 340 000 deaths, making it the fourth most frequent cancer in women, after lung, colorectal, and breast cancer². Cervical cancer is a risk for 29 million Ethiopian women who are 15 years of age or older².

The fact that 88% of cervical cancer deaths and roughly 83% of new cases occur in LMICs makes it noteworthy. In 36 countries, including sections of sub-Saharan Africa, Latin America, and India, cervical cancer does, in fact, cause the majority of cancer-related deaths³. Due to the immunosuppression caused by HIV infection and the longer life expectancy brought on by anti-retroviral therapy (ART), cervical cancer has become one of the most common cancers in women with HIV⁴.

The prevalence of HPV rises as cervical abnormalities get more severe; it ranges from 12% in normal cytology to 89% in invasive cervical cancer. The prevalence of HR-HPV is much higher in women with abnormal cervical cytology (92.4%) than in those without abnormal cytology (71%)⁵. Pre-cancer lesions are less likely to regress in women living with HIV (WLWH), and recurrence rates are higher as a result of the faster progression of HR HPV infection to pre-cancer lesions and CC⁶.

Genital HPV types are divided into high-risk (HR) and low-risk (LR) categories based on epidemiological studies that look at their capacity to cause invasive malignancy. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 of HPV are now categorized as HR, types 26, 53, and 66 as potentially HR, and types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, and 81 as LR⁷.

The HR HPV DNA test is a Cervical Cancer (CC) screening test, which detects the presence or absence of HPV, the virus that causes CC. Priority is given to women living with HIV for HPV testing at an earlier age starting from the time HIV is detected and to re-screen every two years⁸.

Only a few epidemiological studies carried out in Ethiopia have demonstrated that oncogenic HPV infection is responsible for over 90% of invasive cervical malignancies⁸.

HIV is thought to raise a person’s risk and susceptibility to oncogenic HPV infections, which can accelerate the development of invasive cervical carcinoma (ICC). HIV-positive women with chronic HR-HPV infection had abnormal cytology in 86% of cases, and more frequently than HIV-negative women. HIV-positive women with persistent HR-HPV infection had a 38% risk of being diagnosed with HSIL or worse cytology⁹.

Cytological data suggests that women with HIV are more likely to experience high-risk HPV type infections, which can lead to invasive cervical cancer and high-grade squamous intraepithelial lesions (HSIL)⁴. HIV infections are believed to be the cause of changes in the range of HPV types in both invasive cervical carcinomas and normal cervical epithelium, leading to a complex morbidity in the interaction between the two viruses¹⁰.

Optimal preventive vaccination and early disease detection are essential for the optimal management of cervical cancer, particularly in women with HIV. It is very impossible to estimate the prevalence rate of the disease in women with HIV because routine screening for cervical abnormalities is not commonly carried out. To the best of our knowledge, no epidemiological research has been done on the distribution of HPV types in women with HIV who have cytological abnormalities in Bahir Dar, northwest Ethiopia. The aim of this study was to determine the HPV prevalence and type-specific distribution among HIV-positive women with cervical cytologic abnormalities in Bahir Dar, northwestern Ethiopia.

Materials and methods

A cross-sectional facility-based study was conducted among HIV-positive women in Bahir Dar, northwestern Ethiopia, between January and March 2025. A total of 344 women living with HIV were enrolled in the study. HIV-positive women were offered screening with partial genotyping of the HPV DNA test and cervical cytology examination with the PAP test. Participants with no other known chronic diseases and no history of cervical neoplasia or urectomy were eligible. All participants gave informed consent to participate in the study.

Data collection tools and procedure

A standardized questionnaire was used to collect socio-demographic, reproductive, sexual behavior and clinical data. Medical records were reviewed to extract data on the use of ART treatment and management and other laboratory records. Trained gynecologists currently working on cervical cancer unit collect data using standardized questionnaire, provide gynecological, physical examinations and collect swab for HPV DNA test and cytological examinations,

Laboratory investigations and cervical cytology

All 344 study participants were screened for HPV DNA and cervical cytology. HR-HPV DNA tests detect high-risk HPV DNA in vaginal or cervical swabs. A HR-HPV testing were performed by the clinically validated COBAS 4800 HPV assay (Roche Molecular Systems, Pleasanton, CA, USA), based on real-time polymerase chain reaction (RT-PCR) technology. The method detects 14 HPV types (the 12 designed as high-risk by the IARC, plus types 68 and 66) and provides specific results for HPV16 and HPV18, and altogether for the other 12 types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68b) referred to as non16/18HPV. The smears were stained with the Pap stain and were independently diagnosed by two experienced cytopathologists. When the diagnosis differed between the two cytopathologists, the sample was reviewed by a third cytopathologist and consensus obtained. Cytology results were diagnosed according to the 2001 Bethesda system and classified as negative for intraepithelial lesion or malignancy, ASC-US, ASC-H, LSIL, HSIL, and squamous cervical carcinoma. A diagnosis of ASCUS or higher was considered cytological abnormality.

Data processing and analysis

Collected data were reviewed, coded, and entered into Epi info version 7.2.5 and exported to SPSS version 26.0 for further analysis. Descriptive statistics such as frequency and cross tabulation were performed to summarize the data. Bivariate logistic regression analysis was performed to test the relationship between individual variables and the outcome variable. Those variables that had a significance level of < 0.5 in the bivariate analysis were included in a multivariable logistic regression model for further analysis, and a stepwise backward analysis (likelihood ratio) was performed to account for confounding variables. Odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) were calculated to assess the degree of association between independent and dependent variables. Finally, variables with a p-value of less than 0.05 were considered statistically significant.

Results

Socio-demographic, sexual and reproductive characteristics of study participants

The Socio-demographic, sexual and reproductive characteristics of study participants are summarized in Table 1. A total of 344 HIV-positive women participated in the study. Seventy five (21.8%) of the study participants were illiterate and 52.6% had education above secondary level. Eighty seven (25.3%) were housewives or farmers. One hundred ninety two (55.8%) of respondents were married. Two hundred nine (60.76%) of the participants earned less than 5,000 birr per month.

Table 1.

Socio-demographic, sexual and reproductive characteristics of study participants.

Variables N = 344	Category	Total Frequencies	HPV DNA Results
			High-risk HPV detected	High-risk HPV not detected
Age	< 30	31	6	25
	30–40	140	57	83
	41–50	96	65	31
	51–60	38	24	14
	> 60	39	19	20
Educational status	Illiterate	75	45	30
	Read and write	41	28	13
	Primary education	47	34	13
	Secondary (9–10)	130	47	83
	College and above	51	17	34
Monthly income	< 2000 birr	81	50	31
	2001–5000 birr	128	72	56
	5001–10,000 birr	82	31	51
	> 10,000 birr	53	18	35
Marital status	Single	78	37	41
	Married	192	86	106
	Divorced	25	16	9
	Widowed	49	32	17
Parity	1 to 3	111	24	87
	4 to 6	164	102	62
	7 to 10	54	36	18
	> 10	15	9	6
Occupation	Employed	96	46	50
	Farmers	31	18	13
	Housewife	56	24	32
	Merchant	65	34	31
	Other	96	49	47
Residence	Urban	160	76	84
	Rural	184	95	89
Age at first marriage	< 18	138	92	46
	18–20	119	52	67
	20–25	64	22	42
	> 25	23	5	18
Age at first sexual debut	< 18	141	90	51
	18–20	123	53	70
	20–25	68	23	45
	> 25	12	5	7
Smoking Cigarette	Yes	2	1	1
	No	342	170	172
Drinking Alcohol	Yes	46	18	28
	No	298	153	145
Number of lifetime sexual partners	1	109	16	93
	≥ 2	235	155	80
Condom during sexual intercourse.	Yes	292	135	157
	No	52	36	16
Hormonal contraceptive use	Yes	81	49	32
	No	263	122	141
History of Abortion	Yes	63	29	34
	No	281	142	139
Have you heard about cervical cancer	Yes	96	28	68
	No	248	143	105
If Yes, Source of information	Health professional	26	6	20
	Media	31	14	17
	Family/neighbor	39	8	31
Have you had screening	Yes	28	5	23
	No	316	166	150
Type of screening	Onco E6	7	1	6
	V IA	21	4	17
	Other	0	0	0
History of chronic diseases	Yes	138	86	52
	No	206	85	121
History of STI infection	Yes	214	154	60
	No	130	17	113
Years of ART attendance	< 2 years	28	6	22
	≥ 3 Years	316	165	151
HIV viral load	< 1000 copies/ml	114	32	82
	≥ 1000 copies/ml	230	139	91

In this study, one hundred forty one (40.99%) of participants had their sexual debut before the age of 18 years and 138 (40%) made marriage before the age of 18 years. Two hundred thirty-five (68.3%) of study participants reported having two or more lifetime sexual.

Prevalence and genotype distribution of HR-HPV among women living with HIV

A total of 171 (49.7%) of the 344 women had HR-HPV infection, with type HPV16 37(21.6%), HPV18 15(8.8%), type 16 and others 24(14%), type 18 and others 7(4.1%), type 16 and type 18 6(3.5%), and other types 82 (47.9%). The prevalence of the most common single infections was 52(30.4%) and multiple infections HR-HPV including types 16, 18 and other HR HPV types was 119(69.5%). The details are shown in Table 2.

Table 2.

The distribution of high-risk HPV among HIV-positive women with normal and abnormal cervical cytology.

HPV Infection profile	Number (n = 171)	Percentage
Single Infections
HPV 16 only	37	21.60%
HPV 18 only	15	8.8%
Multiple Infections
HPV 16 + Other (not 18)	24	14.0%
HPV 18 + Other (not 16)	7	4.1%
HPV 16 + HPV 18 ± Other	6	3.5%
Other HR-HPV combinations (no 16/18)	82	47.9%
Total HPV Positive	171	100%

Cytological diagnosis of women living with HIV

From the total study participants evaluated for cytology examination, 263 (76.45%) of study participants were normal while 81(23.55%) were abnormal. Of those with abnormal cytology results, 26 (32.1%) were ASC-US, 22 (27.2%) were LSIL, 14 (17.3%) were ASC-H, 9 (11.1%) were LSIL-H, and 10 (12.3%) were HSIL. The details are shown in Table 3.

Table 3.

Cytology results among HIV-positive women with normal and abnormal cervical cytology.

Cytopathology finding	Number of cases	Percentage
Normal	263	76.45
Abnormal	81	23.55
ASC-US	26	32.1
LSIL	22	27.2
ASC-H	14	17.3
LSIL-H	9	11.1
HSIL	10	12.3

Distribution of HR-HPV genotypes in abnormal cervical cytology findings

As shown in Table 4, from the total 344 study participants, 81 of them was with abnormal cervical cytology findings, ASC-US, LSIL, ASC-H, LSIL-H and HSIL + accounted for 26 (32.1%), 22 (27.211.3%), 14 (17.3%), 9 (11.1%) and 10 (12.3%) respectively. Among 263 normal cytology, 93 (35.4%) were positive for HR HPV and 170 (64.6%) were negative for HR HPV. Among 81 abnormal cytology, 78 (96.3%) were positive for HR HPV infection and 3 (3.7%) were negative for HR HPV infection. The prevalence of HR-HPV among ASC-US, LSIL, ASC-H, LSIL-H and HSIL cervical cytology findings accounts 24 (92.3%), 21 (95.4%), 14 (100%), 9 (100%), and 10 (100%) respectively.

Table 4.

Distribution of High-Risk genotypes among HIV positive women with normal and abnormal PAP smear cervical cytology.

Cytopathology	HPV result	Type 16	Type 18	Type 16 and Others	Type 18 and Others	Type 16 and 18	Other types	HPV Neg
Normal	93	23	12	7	3	4	44	170
Abnormal	73	14	3	17	4	2	38	3
ASC-US	24	4(15.4%)	2(7.7%)	3 11.5%)	0(0%)	1(3.8%)	14(53.85%)	2(7.7%)
LSIL	21	3 13.6%)	1(4.5%)	4 18.1%)	1 (4.5%)	0 (0%)	12 (54.5%)	1 4.5%)
ASC-H	14	3 21.4%)	0 (0%)	4 28.6%)	2 (14.3%)	0(0%)	5 35.7%)	0 (0%)
LSIL-H	9	2(22.2%)	0 (0%)	1(11.1%)	0 (0%)	1(11.1%)	5(55.6%)	0 (0%)
HSIL	10	2 (20%)	0 (0%)	5(50%)	1(10%)	0 (0%)	2 (20%)	0 (0%)

Risk factors associated with HR-HPV infections among women living with HIV

Risk factors for HR HPV infection are displayed in Table 5. The risk factors found to be significantly associated with HR HPV infection were Age, Educational status, Monthly income, Parity, Age at first marriage, Age at first sexual debut, Number of lifetime sexual partners, Condom during sexual intercourse, Hormonal contraceptive use, Awareness about cervical cancer, previous screening, History of STI infection, Years of ART attendance, and HIV viral load. However, marital status, occupation, residence, smoking cigarette, drinking alcohol and history of abortion were not associated with HR-HPV infection. HIV positive women with age between 31 and 40, 41–50, 51–60 and age greater than 60 have 2.9 times greater with OR 2.861 95% CI [1.104–7.419], 8.8 times greater with OR 8.773 [3.252–23.474], 7 times greater with OR 7.143 [2.358–21.637] and 4 times greater with OR 3.958 [1.331–11.773] risk to be infected with HR HPV above age less than 30 years respectively (Table 5).

Table 5.

Risk factors associated with HR-HPV infections among women living with HIV.

Variables	Category	Total N	HPV DNA Results		P-value	OR (95% CI)
			High-risk HPV detected	High-risk HPV not detected
Age	< 30	31	6	25		1*
	30–40	140	57	83	< 0.05	2.86 [1.10–7.4]
	41–50	96	65	31	< 0.05	8.77 [3.25–23.47]
	51–60	38	24	14	< 0.05	7.14 [2.3–21.6]
	> 60	39	19	20	< 0.05	3.96 [1.33–11.77]
Educational status	Illiterate	75	45	30	< 0.05	3.00 [1.43–6.31]
	Read and write	41	28	13	< 0.05	4.31 [1.79–10.37]
	Primary education	47	34	13	< 0.05	5.23 [2.20–12.42]
	Secondary (9–10)	130	47	83	0.721	1.13 [0.57–2.24]
	College and above	51	17	34	1*
Monthly income	< 2000 birr	81	50	31	1*
	2001–5000 birr	128	72	56	0.434	0.79 [0.45–1.41]
	5001–10,000 birr	82	31	51	< 0.05	0.38 [0.20–0.72]
	> 10,000 birr	53	18	35	< 0.05	0.31 [0.15–0.64]
Marital status	Single	78	37	41	1*
	Married	192	86	106	0.693	0.89 [0.53–1.524
	Divorced	25	16	9	0.153	1.97 [0.78–4.99]
	Widowed	49	32	17	0.051	2.09 [0.99–4.36]
Parity	1 to 3	111	24	87	1*
	4 to 6	164	102	62	< 0.05	5.96 [3.44–10.35]
	7 to 10	54	36	18	< 0.05	7.25 [3.51–14.96]
	> 10	15	9	6	< 0.05	5.44 [1.76–16.79]
Occupation	Employed	96	46	50	1*
	Farmers	31	18	13	0.327	1.51 [0.66–3.41]
	Housewife	56	24	32	0.546	0.82 [0.42–1.58]
	Merchant	65	34	31	0.585	1.19 [0.64–2.24]
	Other	96	49	47	0.665	1.13 [0.64–1.99]
Residence	Urban	160	76	84	0.445	0.85 [0.56–1.29]
	Rural	184	95	89	1*
Age at first marriage	< 18	138	92	46	1*
	18–20	119	52	67	< 0.05	0.39 [0.23–0.64]
	20–25	64	22	42	< 0.05	0.26 [0.14–0.49]
	> 25	23	5	18	< 0.05	0.14 [0.05–0.39]
Age at first sexual debut	< 18	141	90	51	1*
	18–20	123	53	70	< 0.05	0.43 [0.26–0.70]
	20–25	68	23	45	< 0.05	0.29 [0.16–0.53]
	> 25	12	5	7	0.139	0.41 [0.12–1.34]
Smoking Cigarette	Yes	2	1	1	0.993	1.01 [0.06–16.31]
	No	342	170	172	1*
Drinking Alcohol	Yes	46	18	28	0.126	0.61 [0.32–1.15]
	No	298	153	145	1*
Number of lifetime sexual partners	1	109	16	93	1*
	≥ 2	235	155	80	< 0.05	11.26 [6.21–20.42]
Condom during sexual intercourse.	Yes	292	135	157	< 0.05	0.38 [0.20–0.72]
	No	52	36	16	1*
Hormonal contraceptive use	Yes	81	49	32	< 0.05	1.77 [1.07–2.94]
	No	263	122	141	1*
History of Abortion	Yes	63	29	34	0.519	0.84 [0.48–1.44]
	No	281	142	139	1*
Have you heard about cervical cancer	Yes	96	28	68	< 0.05	0.30 [0.18–0.50]
	No	248	143	105	1*
If Yes, Source of information	Health professional	26	6	20
	Media	31	14	17
	Family/neighbor	39	8	31
Have you had screening	Yes	28	5	23	< 0.05	0.19 [0.07–0.53]
	No	316	166	150	1*
Type of screening	Onco E6	7	1	6
	V IA	21	4	17
	Other	0	0	0
History of chronic diseases	Yes	138	86	52	< 0.05	2.35 [1.51–3.66]
	No	206	85	121	1*
History of STI infection	Yes	214	154	60	0 < 0.05	17.06 [9.45–30.79]
	No	130	17	113	1*
Years of ART attendance	< 2 years	28	6	22	1*
	≥ 3 Years	316	165	151	< 0.05	4.01 [1.58–10.15]
HIV viral load	< 1000 copies/ml	114	32	82	1*
	≥ 1000 copies/ml	230	139	91	< 0.05	3.91 [2.41–6.37]

*Reference category.

Limitation of the study

There were certain limitations to our study that should be taken into account when interpreting our findings. First, the results of the cytology were not confirmed by histology. Second, using detection technology that is already accessible in our lab, the study partially identifies high risk HPV genotypes. Third, because it was a cross-sectional study, there was no follow-up system in place to detect recurrent or persistent HPV infections or the advancement or recurrence of cytological abnormalities.

Discussion

This study investigated partial genotyping of the HPV DNA test and cervical cytology using the PAP test in women living with HIV who visited the gynecology unit of Felege Hiwot Specialized Referral Hospital during the study period. The principal finding of this study showed that the overall prevalence of HR-HPV among these study participants was 171 (49.7%). Overall, there were 81(23.5%) abnormal cervical cytology, ASC-US, LSIL, ASC-H, LSIL-H and HSIL + accounted for 26 (32.1%), 22 (27.211.3%), 14 (17.3%), 9 (11.1%) and 10 (12.3%) respectively.

The current study indicated that the prevalence of HR-HPV, which was 171 (49.7%) of the 344 women infected with HR-HPV, was in close agreement with cross-sectional investigations carried out in public health facilities in the Kweneng East District of Botswana and Cameroon, which had corresponding magnitudes of 40.4% and 46.43%, respectively^11,12. The current study’s findings were higher than those of a study conducted in another region of Ethiopia, which found that the prevalence of HR HPV among WLWH was 173 (35.2%), 95% CI (30.5% − 40.1%) (6). The discrepancy between the two studies may have been caused by differences in geography, socioeconomic status, study area, and study period.

This study revealed that, the overall prevalence of HR-HPV in abnormal cervical cytology among women with HIV was 96.3%. The highest prevalence of high-risk HPV genotypes was found in types other than 16 and 18, which accounted for 43 (55.1%) cases, while genotypes 16 and other HPV infections accounted for 17 (21.8%) cases, type 16 alone accounted for 14 (18%) cases, and type 18 alone accounted for 3 (3.8%) cases. This result is consistent with a study done in Turkey that reported 110 (25.3%) of the 435 h HPV-positive samples had HPV16, 17 (3.9%) had HPV18, and 310 (71.3%) had neither type 16 nor 18¹³. The study conducted in China reported that the five most frequent types were HPV 16 (4.4%), 58 (2.9%), 52 (2.7%), 33 (2.2%), and 11 (1.9%)¹⁴.

This study identified only three (3.7%) patients who tested negative for HR-HPV showed aberrant cervical cytology in their cytological grading. The prevalence of HR-HPV among women with normal cervical cytology was 93 (35.4%) of these, 23 (24.7%) were type 16, 12 (12.9%) were type 18, 7 (7.5%) were type 16 and others, 3 (3.2%) were type 18 and others, 4 (4.3%) were type 16 and 18, 44 (47.3%) were other HPV types, 263 (76.5%) were negative. This finding is greater than that of a study conducted in Turkey that discovered HR-HPV in 18.7% of NILM samples and in 79.7% of samples with aberrant cytology (7). The disparity in the results may be caused by regional and economic disparities.

This study identified that the rate of HR-HPV infection increased with increasing cytological findings: Normal, ASC-US, LSIL, ASC-H, LSIL-H, and HSIL were 35.4%, 92.3%, 95.4%, 100%, 100%, and 100% respectively. This finding is consistent to the study done in China which indicated that the rate of HPV detection increased with the severity of cytological grading, from 13.0% for ASC-US, 30.8% for ASC-H, 39.5% for 56.3%, and 100.0% for LSIL, HSIL, and SCC, respectively¹⁵.

In this study, HR-HPV infection among women living with HIV who had a history of STI was significantly associated with HR-HPV infections which was17 times more than those WLWH who did not have STI infections. This finding was in line with a study conducted in a different region of Ethiopia, which found women with HIV who also had STIs were three times more likely to get HPV than women without STIs (6).

The current study found that women living with HIV who had multiple sexual partners showed an increased risk of HR-HPV infection compared with women living with HIV who had only one sexual partner. This finding is in agreement with a study done in South Africa and another part of Ethiopia which revealed that the risk of HR-HPV infection was nearly doubled for WLWH with many lifetime sexual partners compared to those with only one lifetime sexual partner^4,16.

In this study, we found that HIV positive women who had sexual intercourse at age 18–20, 20–25, and > 25 had a preventive effect for harboring HR-HPV than sexual intercourse below the age of 18. This finding was in line with a study done in China which found the link between early sexual debut and CIN2+, which might be because such sexual conduct elevated the probability of exposure to HPV⁵.

In the present study, Women living with HIV with 4–6, 7–10, and > 10 children had increased risk of infection for HR HPV than women living with HIV with parity less than 3. This result was similar to another study done in China which states the prevalence of HR-HPV increased significantly as gravidity and parity increased, possibly as a consequence of pregnancy’s hormonal changes¹⁷.

In the current study, HIV positive women with greater than 1000 copies/ml viral load had 4 times more risk for HR HPV infection than HIV positive women with less than 1000 copies/ml with OR 3.914 95%CI 2.406–6.367. This finding was consistent with different studies which states the most commonly reported risk factors linked to high-risk HPV infection were high viral load and CD4 count^18–21., and²².

Conclusion

The prevalence of HR-HPV was very high among women living with HIV (49.7%), with 81 (23.5%) of the study participants had abnormal cervical cytology, HR-HPV was detected in 96.3% of patients with abnormal cytology. Women living with HIV need \more frequent cervical cytological diagnosis. The most frequent genotypes circulating among women living with HIV were types other than type 16 and 18. Most affected individuals are middle aged and of low economic status. HR-HPV infection was more influenced by Socio-demographic, sexual and reproductive factors. So that HPV related health intervention programs like, behavioral change, life style change and awareness creation are important. It would also be necessary to strengthen surveillance of HR-HPV through screening, treatment, and vaccination of HIV-infected women.

Authors’ contributions

The corresponding author (AA) was involved in the conception, design, drafted the present manuscript and data analysis. Both authors (AA and MA) were involved in analysis and interpretation of data.

Author contributions

The corresponding author (AA) was involved in the conception, design, drafted the present manuscript and data analysis. Both authors (AA and MA) were involved in analysis and interpretation of data.

Funding

No funding was given to support this study.

Data availability

All the generated data in this article are included in the manuscript. Theoriginal data can be obtained from the corresponding author upon requestAlemayehu Abate [alexu2love@gmail.com](mailto: alexu2love@gmail.com).

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethical approval was obtained from Institutional Review Board (IRB), Bahir Dar University. Written informed consent was ensured from all study participants to take part in the study voluntarily after they get informed about the objective and purpose of the study. This study was performed in accordance with the Declaration of Helsinki.