Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil

Abstract

Background: Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil.Material and methods: Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12.Results: HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa.Conclusion: Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.

An Updated Systematic Review of Human Papillomavirus Genotype Distribution by Cervical Disease Grade in Women Living With Human Immunodeficiency Virus Highlights Limited Findings From Latin America

“…This review sought to identify HPV genotypes by cervical disease grade in WHIV in LAC but identified a lack of published data from LAC, despite having some of the highest rates of HIV, HPV and cervical cancer. There are 2 recent studies from Brazil that demonstrated that WHIV are more likely to have an oncogenic HPV infection, that HPV genotypes varied in the cervix versus the oropharynx, and that WHIV had higher prevalence of cytological abnormalities 24,25 . Suehiro et al, 24 reported that among 231 WHIV, 6 women (2.6%) had HSIL with a HR-HPV infection but did not have specific genotyping performed.…”

“…There are 2 recent studies from Brazil that demonstrated that WHIV are more likely to have an oncogenic HPV infection, that HPV genotypes varied in the cervix versus the oropharynx, and that WHIV had higher prevalence of cytological abnormalities 24,25 . Suehiro et al, 24 reported that among 231 WHIV, 6 women (2.6%) had HSIL with a HR-HPV infection but did not have specific genotyping performed. Of all new cases of cervical cancer diagnosed 86% will occur in Africa, LAC, and portions of Asia, yet most data guiding HPV-based cervical screening comes from Africa or Europe/North America 16 .…”