Shedding of Epstein-Barr Virus and Cytomegalovirus from the Genital Tract of Women in a Periurban Community in Andhra Pradesh, India

Abstract

We found a large number of false-positive readings by visual inspection with acetic acid (VIA) in a study of cervical cancer screening strategies (VIA, human papillomavirus HPV DNA testing, and Pap cytology) in a periurban community in Andhra Pradesh, India. We evaluated whether these false-positive readings might be occurring as a result of infections with Epstein-Barr virus (EBV) or cytomegalovirus (CMV), prevalent latent herpesviruses known to be shed from the female genital tract. While we found that there was no association between VIA results and the presence of EBV or CMV in the cervix, we did find a high prevalence of both viruses: 20% for EBV and 26% for CMV. In multivariate analyses, CMV prevalence was associated with younger age, lack of running water in the home, and visually apparent cervical inflammation. EBV prevalence was associated with older age and a diagnosis of cervical intraepithelial neoplasia grade 1 or greater. The biological and clinical implications of these viruses at the cervix remain to be determined. The strong association between the presence of EBV and cervical disease warrants future exploration to determine whether EBV plays a causal role in disease development or if it is merely a bystander in the process.We conducted a study of cervical cancer screening strategies in a periurban community near Hyderabad in the state of Andhra Pradesh in southern India. Cervical cells were collected from women for cytological and virological investigation, and the cervix was examined with naked eye visual inspection after application of acetic acid (VIA). We found that a positive VIA reading (presence of an acetowhite lesion in the cervical transformation zone) had a surprisingly low sensitivity (26.3%) and moderate specificity (76.4%) for the detection of cervical neoplasia (9,28).Given the large number of false-positive VIA readings, we inquired if these lesions might be occurring as a result of infections with Epstein-Barr virus (EBV) or cytomegalovirus (CMV), prevalent latent herpesviruses which are known to be shed from the female genital tract (2, 6, 14, 21). We also examined whether cervical EBV and CMV detection correlated with either cervical HPV detection or other markers of cervical pathology, since these viruses have been postulated to have a possible cocarcinogenic role with human papillomavirus (HPV) for cervical neoplasia (19, 23). MATERIALS AND METHODSStudy participants. The study subjects were a subpopulation of the CATCH (Community Access to Cervical Health) project, a population-based screening study in a periurban community near Hyderabad, in the state of Andhra Pradesh, India. The CATCH project aimed to enroll all eligible women 25 years of age and older who were not pregnant and who had not had a hysterectomy. A total of 2,331 women, or approximately 40% of those eligible, were enrolled and consented to an interviewer-administered questionnaire to collect data on demographics, reproductive health, cervical cancer screening history, and smoking status. Participants also pr...

Low CD4 Counts and Early Sexual Debut Predict Genital Cytomegalovirus Infection among HIV Infected Women in Mwanza, Tanzania

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