Persistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher rate of persistent infections and an earlier progression to cancer. We aimed to evaluate HR-HPV prevalence, incidence and clearance, and its association with HIV viral suppression, immunological response and other risk factors among WLHA followed at an STD/HIV reference center. This was a cohort study conducted at a reference center for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months after enrolment, where socio-epidemiological data were obtained. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS® Roche) in addition to blood samples for CD4+ T lymphocyte count and HIV viral load. We prospectively evaluated 333 women. HR-HPV DNA prevalence was 33.3% at baseline. HPV-16 was present in 5.1%, HPV-18 in 3.9% and 29.4% WLHA had other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). The HR-HPV incidence during the follow-up was 10.8%, at the 6-month visit was 7.7% and at the 12-month visit was 3.7%. Variables associated with HR-HPV incidence were: nulliparity, combined oral contraceptive use and detectable HIV viral load. The HR-HPV clearance rate was 41.7% and was associated with age >30 years and lymphocyte T CD4 count >500 cells/mm3 at enrolment. These findings contribute to the knowledge about a group of women that need more careful HPV screening and describe the association between an efficient immunological response and HIV viral suppression with lower incidence and increased clearance of HR-HPV.

Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

Introduction: Ureaplasma urealyticum and Mycoplasma hominis are frequently found at many women’s and men’s urogenital tract, and have been associated with non-gonococcal urethritis, cervicitis, infertility, chorioaminionitis and adverse pregnancy outcomes. Some studies show high prevalence of human papillomavirus (HPV) in patients with non-gonococcal urethritis, while also presenting high frequency of Ureaplasma urealyticum infection in women with cervicalcytology abnormalities and men with genital warts. Objectives: To evaluate the prevalence of Ureaplasma urealyticum, Mycoplasma hominis and HPV coinfection in people attending a sexually transmitted infections (STI)/HIV reference centre and to identify the risk factors associated. Methods: A cross-sectional study with patients aged >18 years, carried out for Ureaplasma urealyticum and Mycoplasma hominis from July 1st to December 31, 2015, in a STI/HIV reference centre from the State of Bahia, Brazil. Sociodemographic and clinical data were obtained from secondary data from patients’ charts and laboratory findings, and analyzed using SPSS 20.0. Pearson’s χ2 test or Fisher’s exact test was used to evaluate categorical variables. HPV clinical diagnosis was considered positive as the presence of genital warts. Results: In this study, 849 patients were included — 196 men and 653 women. Of the sample, 51.4% was diagnosed with at least one of the two bacteria. The prevalence of Mycoplasma hominis infection was higher in coinfection (16.7%) than in isolated infection (2.2%). The prevalence of Ureaplasma urealyticum isolated infection was 32.4%. A strong association was found between the presence of genital warts and Ureaplasma urealyticum infection, with an estimated risk of 1.230 (p=0.014). Conclusion: Our findings suggest the need for further investigation for Ureaplasma urealyticum infection in patients presenting genital warts on physical examination. In addition, in this context, greater attention should be given to women and pregnant women.

IntroductionPersistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher parcel of persistent infections and an earlier progression to cancer. We aimed to evaluate the HR-HPV infection and clearance, and its association with HIV viral suppression, immunological response, and other risk factors among WLHA followed in a STD/HIV reference centre.MethodsThis is a cohort study conducted at a reference centre for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months from enrolment, where socio-epidemiological data was obtained through standardised form. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS Roche) in addition to blood samples for TCD4+ lymphocyte count and HIV viral load.ResultsWe prospectively evaluated 333 women. HR-HPV DNA prevalence was 39.6% during the follow-up. HPV-16 was present in 6.0%, HPV-18 in 5.4% and 37.8% WLHA had other HR-HPV (31,33,35,39,45,51,52,56,58,59,66 and 68). The HR-HPV incidence was 10.6% in 6 months visit and 6.5% in 12 months visit. Variables associated with HR-HPV incidence were: age ≤30 years, combined oral contraceptive use, smoking and detectable HIV viral load. The HR-HPV clearance was 31.7% and was associated with age >30 years and lymphocytes count >350 cels/mm3 at enrolment. Nulliparous women had higher HR-HPV clearance rates.ConclusionThese findings have contributed to the knowledge about the group of women that need a more careful HPV screening, while described the association of efficient immunological response and HIV viral suppression with a lower HR-HPV incidence and increased clearance of HPV-HR.