MIRERC 055/2025: LONGITUDINAL STUDY OF PERSISTENT HIGH-RISK HUMAN PAPILLOMAVIRUS INFECTION IN WOMEN LIVING WITH HIV IN MERU, KENYA

Abstract

Background: Cervical cancer remains the leading cause of cancer-related deaths among women in
Kenya, with high-risk human papillomavirus (hrHPV) as the primary etiological agent. Women living
with HIV (WLHIV) are disproportionately affected due to immunosuppression. The interactions
between hrHPV persistence, sexually transmitted infections (STIs), cytokine imbalances, and vaginal
microbiome disruptions is not fully understood in this population.
Objective: This study aims to investigate the determinants of persistent hrHPV infection among
WLHIV in Meru County, Kenya, focusing on STI co-infections, cytokine profiles, vaginal microbiome
structure, and sexual behavior patterns over a five-year period.
Methods: We will recruit 500 WLHIV, including 242 from a prior cohort. Annual clinical exams,
vaginal swabs, and blood samples will be collected. Data will be collected on behavioral
characteristics and other risk factors associated with STIs and HPV infection. HPV and STI screening
will be performed using GeneProof PCR kits, cytokines measured via ELISA, and vaginal
microbiomes profiled using 16S rRNA sequencing on Illumina MiSeq. Statistical analyses will be
conducted in R 4.4.1, using logistic regression and longitudinal mixed models.
Expected Outcomes: The study will generate data that will improve understanding of how into
microbial, immunological, and behavioral factors influencing hrHPV persistence. This will inform
new prevention strategies such as vaginal probiotics, immune-targeted therapies, and public health
interventions tailored to WLHIV.