Persistent Low-Risk and High-Risk Human Papillomavirus Infections of the Uterine Cervix in HIV-Negative and HIV-Positive Women

Abstract

BackgroundThe prevalence, persistence, and multiplicity of human papillomavirus (HPV) infection appears different comparing HIV-positive to HIV-negative women. In this study, we examined prevalent, persistent, and multiple low- and high-risk cervical HPV infections in HIV-negative and HIV-positive women.MethodsWe studied 1,020 women involved in a study of HPV infection using SPF25/LiPA10. Two study visits were scheduled, at enrollment and 6 months afterward. At each study visit, research nurses used a cervical brush to collect samples of exfoliated cervical cells from the cervical os, from all the study participants. Exact logistic regression models were used to estimate associations between HIV and HPV infections.ResultsThe mean (SD) age of the study participants was 38 (8) years, 56% were HIV-negative and 44% were HIV-positive. Among HIV-negative women at baseline, single low-risk HPV (lrHPV) infections occurred in 12%; multiple lrHPV in 2%; single high-risk human papillomavirus (hrHPV) infections in 9%, and multiple hrHPV infections in 2%. Single lrHPV infections were persistent in 6%, but there was no persistent multiple lrHPV infections. Single hrHPV infections were persistent in 4% while multiple hrHPV infections were persistent in 0.3%. Among HIV-positive women at baseline, single lrHPV infections occurred in 19%, multiple lrHPV in 6%, single hrHPV infections in 17%, and multiple hrHPV infections occurred in 12%. Single lrHPV infections were persistent in 9%, multiple lrHPV infections in 0.6%, single hrHPV infections in 13%, while multiple hrHPV were persistent in 3%. Prevalent, persistent, and multiple infections were more common in HIV-positive women, compared to HIV-negative women. In multivariate models adjusted for age, marital status, socioeconomic status, age at sexual initiation, and douching, the odds ratios comparing HIV-positive to HIV-negative women, were 2.09 (95% CI 1.47–2.97, p < 0.001) for prevalent lrHPV, 1.26 (95% CI 0.66–2.40, p 0.47) for persistent lrHPV infections, 3.38 (95% CI 2.34–4.87, p < 0.001) for prevalent hrHPV, and 4.49 (95% CI 2.26–8.91, p < 0.001) for persistent hrHPV infections.ConclusionHIV infection was associated with higher prevalence of lrHPV, hrHPV, and persistence hrHPV infections, but not persistent lrHPV infections.

Persistence rate of cervical human papillomavirus infections and abnormal cytology in Rwanda

“…More than half of HIV‐positive women positive for HPV at baseline developed persistent HPV infections, which is similar to the degree of persistence for HIV‐positive women reported from studies in South Africa and Burkina Faso . HIV‐positive women were also more susceptible than HIV‐negative women to acquire incident HPV infections, in accordance with previous studies . While the rates of AIDS‐related cancers such as Kaposi's sarcoma have decreased since the introduction of combination antiretroviral therapy (cART), a similar trend has not been observed for cervical cancer .…”

Human papilloma virus-related premalignant and malignant lesions of the cervix and anogenital tract in immunocompromised women

“…Data suggest that HPV infections in these patients might not only occur more frequently, but that their course might also lead to faster oncogenesis [11]. It was proved in a study by Adebamowo et al, that HIV-positive females, when compared with HIV-negative subjects presented a significantly higher prevalence of lrHPV and hrHPV and a persistence of hrHPV [12]. These findings are supported by those of the meta-analysis by Looker et al, which proved that in the presence of HIV infection, the risk of HPV acquisition doubles, and for clearance halves, especially with a decline in the CD 4 cell count.…”

“…Some studies suggest that in HIV-positive patients, there are additional factors, apart from immunosuppression, that contribute to the increased prevalence and persistence of HPV infections. This might be due to direct interactions of the viral genes of HIV and HPV or to changes in reactions of the cytokines in cervical mucus to HPV [12].…”

Multistate Markov Model to Predict the Prognosis of High-Risk Human Papillomavirus-Related Cervical Lesions

“…Among the hrHPVs, HPVs 16 and 18 are the most frequently observed genotypes in patients with cervical cancer, and approximately 70% of cervical cancers are HPV 16 or 18 positive [4,16]. Several studies, including prospective cohort studies, demonstrated that the risk of HPV 16-positive patients to develop CIN2 or CIN3 lesions is higher than that reported in patients positive for other hrHPVs [12,[17][18][19]. Matsumoto et al revealed that seven hrHPV types, including HPV 16, show a high rate of progression of CIN1-2 to CIN3 compared with the other hrHPVs [12].…”