Cervicovaginal human papillomavirus infection in human immunodeficiency virus-1 (HIV)-positive and high-risk HIV-negative women.
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 > or = 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.
Department of Laboratory Medicine, University of California, San Francisco 94143, USA. joelp@labmed.ucsf.edu
J M
JM
Palefsky
H
H
Minkoff
L A
LA
Kalish
A
A
Levine
H S
HS
Sacks
P
P
Garcia
M
M
Young
S
S
Melnick
P
P
Miotti
R
R
Burk
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000821:virology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D018023:HIV Seronegativity; D006801:Humans; D016015:Logistic Models; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000821:virology*; D011230:Precancerous Conditions / Q000821:virology*; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000821:virology; D002575:Uterine Cervicitis / Q000821:virology*; D014627:Vaginitis / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000821:virology
D012367:RNA, Viral