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Published on: March 8, 2012
Long-term cumulative detection of human papillomavirus among HIV seropositive women
L Stewart Massad1, Xianhong Xie, Robert Burk
1aWashington University School of Medicine, St Louis, Missouri bAlbert Einstein College of Medicine, Bronx cMaimonides Medical Center, State University of New York, Downstate, Brooklyn, New York dJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland eOffice of the U.S. Global AIDS Coordinator, U.S. Department of State, Washington, District of Columbia fUniversity of California, San Francisco, California gGeorgetown University School of Medicine, Washington, District of Columbia hCity of Hope National Medical Center, Duarte, California iRush Medical College and Cook County Bureau of Health Services, Chicago, Illinois, USA.
Objective:
To estimate the effects of infection by HIV on the type-specific cumulative detection of cervicovaginal infection by human papillomavirus (HPV).
Design:
Retrospective assessment of prospectively collected data in a multicenter US cohort.
Methods:
HIV-seropositive and at-risk seronegative participants in the Women's Interagency HIV Study were followed semiannually for up to 11 years. HPV typing was determined from cervicovaginal lavage specimens by PCR; types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 were considered carcinogenic.
Results:
Among the 3438 women enrolled (2543 HIV-seropositive, 895 seronegative), the cumulative detection of any HPV infection rose among HIV-seropositive women from 53% at baseline to 92% at 8 years, and among seronegative women from 22 to 66% (P < 0.0001 for HIV-seropositive vs. seronegative women). The 8-year cumulative detection of carcinogenic and noncarcinogenic HPV was 67 and 89% among HIV-seropositive, and 36 and 56% among seronegative women (P = 0.001 for both carcinogenic and noncarcinogenic HPV). The 8-year cumulative detection of HPV16 and HPV18 was 15.2 and 15.0% in HIV-seropositive, and 6.7 and 6.1% in HIV-seronegative women (P < 0.0001 for both). In multivariable regression analyses, lower CD4(+) cell count, age under 30 years, and smoking, but not number of lifetime sexual partners, were significant correlates of cumulative HPV detection.
Conclusion:
More than 90% of the HIV-seropositive women have HPV detected during a long follow-up. The rates are lower among at-risk HIV-seronegative women, though most also develop HPV infections.
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