Factors associated with ano-genital warts among human immunodeficiency virus (HIV) infected patients at a Hillbrow clinic in Gauteng South Africa
Date
2014-08-27
Authors
Sibanda, Qinisile
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Abstract
Introduction
Ano-genital warts affect at least 30 million people worldwide. Ano-genital warts are caused
by low risk Human Papilloma virus infections in 90% of cases. In African populations the
ano-genital warts have not been adequately investigated thus our main goal was to highlight
the factors associated with the occurrence of ano-genital warts among HIV infected
individuals. Studies in both men and women have shown that the likelihood of getting anogenital
warts is significantly increased when one is infected with HIV hence the need to
investigate in this population. More over data suggests that HPV infection occur more
frequently among HIV infected individuals because of the HIV associated CD4+ T-cell
immune-suppression.
Methods
We conducted an analytical cross sectional study of routinely collected secondary medical
data from Ward 21 ART clinic at the Hillbrow community centre in Hillbrow Johannesburg
central. Our study participants were all HIV infected patients 16 years and older who
attended the ART clinic between 01 January 2009 and 31 December 2011 and were recorded
in the therapy edge database. Our outcome was clinically diagnosed ano-genital warts. We
analysed data using the Chi squared test or Fischers exact test to make comparisons in
bivariate analysis. Logistic regression was used to assess factors associated with ano-genital
warts. Factors assessed were other STIs namely syphilis, herpes simplex virus type 2 and
scabies as well as age, gender, first CD4 and employment status and ART status of a patient.
The Models were assessed using the linktest and the Hosmer Lemeshow goodness of fit test.
Results
Ano-genital warts (AGWs) prevalence was 4% (251 out of 6634) among females and 3%
(118 out 4116) among males. Prevalence of AGWs in both females and males decreased with
increasing age. In females the prevalence was between 1% and 8% and in males it was
between 1% and 4%. The odds of having ano-genital warts among females if one was above
25 years ranged from 1.6 to 18.3, showing an upward trend. Among females a CD4 count of
less than 200 cells/ml3 was also associated with ano-genital warts occurrence, OR 1.32(1.02 -
1.72). Among males the odds of having ano-genital warts if one was not on ART were 1.53
(1.01 – 2.31) times when compared to those who were on ART.
Discussion and Conclusion
Prevalence of genital warts was highest among the younger age groups in both males and
females and it decreased with increasing age consistent with literature. Age was strongly
associated with ano-genital warts and the association became stronger with increasing age
among females while no association was found among males. In line with findings from
other studies we found low CD4 count of ≤ 200 cells/m3 to be associated with ano-genital
warts in HIV positive females; however it was a weak association. Among males a weak
association between ART status and ano-genital warts was established and none in females.
This is consistent with the fact that in the post ART era there has been no substantial decline
in HPV infections.
Description
Thesis (M.Sc. Med.) (Epidemiology and Biostatistics))--University of the Witwatersrand, Faculty of Health Sciences, 2014.