HIV seropositive women face high risk for infection with
oncogenic types of human papillomaviruses (oncHPV), abnormal Pap tests and
precancer, but cervical cancer risk is only modestly increased. HPV16 is highly
oncogenic but only weakly associated with HIV-status and immunosuppression,
suggesting HPV16 may have a greater innate ability to evade host immune
surveillance than other oncHPV types which in turn should result in a greater
relative increase in the prevalence of other oncHPV types among women with
cervical precancer.
To assess whether the under-representation of HPV16 among
HIV-seropositive relative to HIV-seronegative women remains among those with
cervical precancers.
HIV seropositive and seronegative women in the Women's
Interagency HIV Study were screened for cervical intraepithelial neoplasia
grade 3 or worse (CIN3+). DNA from >40 HPV types was detected by PCR in
cervicovaginal lavage specimens obtained at the visit at which CIN3+ was
diagnosed.
HPV16 was detected in 13 (62%) of 21 HIV-seronegative women
with CIN3+ but only 44 (29%) of 154 HIV-seropositive CIN3+ (P=0.01). The lower
prevalence of HPV16 in CIN3+ among HIV seropositive women persisted after
controlling for covariates (O.R. 0.25, 95% C.I. 0.08, 0.78). The prevalence of
other members of the HPV16-related alpha-9 oncHPV clade as a group was similar
in HIV-infected and uninfected women with CIN3+ (OR=1.02, 95% C.I. 0.53, 1.94).
The prevalence of non-alpha-9 oncHPV types was increased in HIV seropositive vs
seronegative women with CIN3+ (OR=3.9, 95% C.I. 1.3, 11.8).
The previously demonstrated increase in CIN3+ incidence
among HIV seropositive women is associated with lower HPV16 and higher non-alpha-9
oncHPV prevalence. This is consistent with prior reports that HIV has a weak
effect on infection by HPV16 relative to other oncHPV and supports use of
nonavalent HPV vaccine in HIV seropositive women.
Via: http://goo.gl/KMVxYz Purchase
full article at: http://goo.gl/Gc6i01
By: Massad LS1, Xie X2, Burk RD2, D'Souza G3, Darragh TM4, Minkoff H5, Colie C6, Burian P7, Palefsky J8, Atrio J2, Strickler HD2.
- 1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
- 2Albert Einstein College of Medicine, Bronx, NY.
- 3Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
- 4Departments of Pathology and Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
- 5Maimonides Medical Center, Brooklyn, NY.
- 6Georgetown University, Washington, DC.
- 7Los Angeles County-University of Southern California Medical Center, Los Angeles, CA.
- 8University of California, San Francisco, CA.
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