Cervicovaginal Human Papillomavirus Infection in Human Immunodeficiency Virus-1(HIV)-Positive and High-Risk HIV-Negative Women

• Published in: JNCI : Journal of the National Cancer Institute Vol. 91; no. 3; pp. 226 - 236
• Main Authors: Palefsky, Joel M., Minkoff, Howard, Kalish, Leslie A., Levine, Alexandra, Sacks, Henry S., Garcia, Patricia, Young, Mary, Melnick, Sandra, Miotti, Paolo, Burk, Robert
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 03.02.1999; Oxford Publishing Limited (England)
• Subjects: Adult; AIDS-Related Opportunistic Infections - complications; AIDS-Related Opportunistic Infections - virology; AIDS/HIV; Biological and medical sciences; Cancer; CD4 Lymphocyte Count; Cervical Intraepithelial Neoplasia - virology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; HIV; HIV - genetics; HIV - immunology; HIV - isolation & purification; HIV Seronegativity; Human immunodeficiency virus; Human immunodeficiency virus 1; Human papillomavirus; Human viral diseases; Humans; Infections; Infectious diseases; Logistic Models; Medical sciences; Papillomaviridae; Papillomavirus Infections - virology; Precancerous Conditions - virology; Prevalence; Reproductive system; Risk Factors; RNA, Viral - analysis; Tumor Virus Infections - virology; Tumors; Uterine Cervical Neoplasms - virology; Uterine Cervicitis - virology; Vaginitis - virology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Women; Human; HIV-1 virus; Retroviridae; Vagina; Papovaviridae; Uterine cervix; Case control study; Lentivirus; Carcinogenesis; Papillomavirus; Virus; Infection; Concomitant disease; Human papillomavirus; Viral disease; Risk factor; Female; Human immunodeficiency virus
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/91.3.226

BACKGROUND: Human papillomavirus (HPV) infection is associated with precancerous cervical squamous intraepithelial lesions commonly seen among women infected with human immunodeficiency virus-1 (HIV). We characterized HPV infection in a large cohort of HIV-positive and HIV-negative women participating in the Women's Interagency HIV Study to determine the prevalence of and risk factors for cervicovaginal HPV infection in HIV-positive women. METHODS: HIV-positive (n = 1778) and HIV-negative (n = 500) women were tested at enrollment for the presence of HPV DNA in a cervicovaginal lavage specimen. Blood samples were tested for HIV antibody status, level of CD4-positive T cells, and HIV RNA load (copies/mL). An interview detailing risk factors was conducted. Univariate and multivariate analyses were performed. RESULTS: Compared with HIV-negative women, HIV-positive women with a CD4+ cell count of less than 200/mm3 were at the highest risk of HPV infection, regardless of HIV RNA load (odds ratio [OR] = 10.13; 95% confidence interval [CI] = 7.32-14.04), followed by women with a CD4+ count greater than 200/mm3 and an HIV RNA load greater than 20 000 copies/mL (OR = 5.78; 95% CI = 4.17-8.08) and women with a CD4+ count greater than 200/mm3 and an HIV RNA load less than 20 000 copies/mL (OR = 3.12; 95% CI = 2.36-4.12), after adjustment for other factors. Other risk factors among HIV-positive women included racial/ethnic background (African-American versus Caucasian, OR = 1.64; 95% CI = 1.19-2.28), current smoking (yes versus no; OR = 1.55; 95% CI = 1.20-1.99), and younger age (age <30 years versus ⩾ 40 years; OR = 1.75; 95% CI = 1.23-2.49). CONCLUSIONS: Although the strongest risk factors of HPV infection among HIV-positive women were indicators of more advanced HIV-related disease, other factors commonly found in studies of HIV-negative women, including racial/ethnic background, current smoking, and age, were important in HIV-positive women as well.