Persistence rate of cervical human papillomavirus infections and abnormal cytology in Rwanda* MF Mukanyangezi, 1,2 B Rugwizangoga, 2,3,4 O Manzi, 4 S Rulisa, 2,4 K Hellstrand, 3 G Tobin, 1 A Martner, 3 E Bienvenu 2 and D Giglio 1,5 1 Department of Pharmacology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden, 2 College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, 3 Tumour Immunology (TIMM) Laboratory, Sahlgrenska Cancer Center, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden, 4 University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda and 5 Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden Objectives In this study, we determined the incidence and persistence of human papillomavirus (HPV) strains and of squamous intraepithelial lesions (SIL) or worse cytology in 237 HIV-positive and HIV- negative Rwandan women and whether the interleukin (IL)-28B single nucleotide polymorphism (SNP) at rs12979860 correlated with susceptibility to and persistence of HPV infection. Methods Cervical samples were collected at baseline and after 9, 18 and 24 months for a 40-HPV DNA screening test and a ThinPrep Pap test. Genotyping of the IL-28B SNP rs12979860 was performed using real-time polymerase chain reaction (PCR). Results Chronic high-risk (HR) HPV infections occurred in 56% of HIV-positive women, while no HIV- negative women developed HPV chronicity. High-grade SIL (HSIL) or cancer was diagnosed in 38% of HIV-positive women with persistent HR-HPV infections. HIV and HR-HPV positivity at baseline were factors associated with an increased risk of HPV persistence. Additionally, HR-HPV positivity at baseline was associated with an increased risk of developing HSIL or worse cytology. The unfavourable T/x genotype at rs12979860 is common among Africans, and women with this genotype were found to be more commonly infected with HPV. Conclusions HPV screening in Rwanda may help to identify women at risk of developing cervical cancer and polymorphism in IL-28B may be associated with risk of contracting HPV infection. Keywords: high-grade squamous intraepithelial lesions, human papillomavirus, interleukin 28B, low-grade squamous intraepithelial lesions, Rwanda Accepted 13 June 2019 Introduction Cervical cancer contributes greatly to cancer-related mor- bidity and mortality among women in sub-Saharan Africa in countries such as Rwanda [1]. It is well estab- lished that chronic infection with human papillomavirus (HPV) of the uterine cervix is the most important risk factor for the development of cervical squamous intraep- ithelial lesions and cervical cancer [2,3]. In our previous study, we showed a high prevalence of HPV infections and cytological abnormalities among Rwandan women, particularly in women who were HIV positive [4]. The degree of HPV chronicity in the Rwandan population is not known. A vaccination programme was implemented in schoolgirls in Rwanda in 2011 with high coverage [5]. The impact of the vaccination programme on cervical cancer incidence is not known, as it takes several years for cervical cancer to develop. We showed that the per- centage of women undergoing cervical cancer screening was low [4]. Monetary issues and not being educated Correspondence: Dr Daniel Giglio, Department of Pharmacology, Univer- sity of Gothenburg, POB 431, SE-405 30, Gothenburg, Sweden. Tel: +46 709694094; fax: +46 317863164; e-mail: daniel.giglio@pharm.gu.se *Some of the data in this study were presented at International Conference on HPV & Cancer-Recent Advances, 13 January 2019, Malabar Cancer Centre, Thalassery, Kerala, India. 485 DOI: 10.1111/hiv.12782 © 2019 British HIV Association HIV Medicine (2019), 20, 485--495 ORIGINAL RESEARCH