Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women.
BACKGROUND
Human papillomavirus (HPV) type 16 is etiologically associated with approximately half of all cervical cancers. It is important, therefore, to determine the characteristics that distinguish HPV16 from other HPV types. A preliminary result based on cross-sectional baseline data in the Women's Interagency Human Immunodeficiency Virus (HIV) Study (WIHS) suggested that the prevalence of HPV16 might have a weaker association with immune status in HIV-seropositive women than that of other HPV types. To address this issue, we examined HPV test results from repeated study visits in the WIHS and from an independent study, the HIV Epidemiology Research Study (HERS).


METHODS
HIV-seropositive women in the WIHS (n = 2058) and in the HERS (n = 871) were assessed semiannually. HPV DNA was detected in cervicovaginal lavage specimens by using polymerase chain reaction assays. Prevalence ratios were used to compare the prevalence of each HPV type in women with the lowest CD4+ T-cell counts (<200 T cells/mm3) with that of women with the highest CD4+ T-cell counts (> or =500 T cells/mm3). A summary prevalence ratio for each HPV type (i.e., across visits and studies) was estimated using generalized estimating equations. The association of CD4+ T-cell stratum with type-specific HPV incidence was measured using multivariable Cox regression models. All statistical tests were two-sided.


RESULTS
The prevalence ratio for HPV16 was low compared with that of other HPV types at every study visit in both cohorts. The generalized estimating equation summary prevalence ratio for HPV16 (1.25, 95% confidence interval [CI] = 0.97 to 1.62) was the smallest measured, and it was statistically significantly lower than that of all other HPV types combined (P =.01). The association of CD4+ T-cell stratum with HPV16 incidence was also among the smallest measured (hazard ratio = 1.69, 95% CI = 1.01 to 2.81).


CONCLUSIONS
The prevalent and incident detection of HPV16 is more weakly associated with immune status in HIV-seropositive women than that of other HPV types, suggesting that HPV16 may be better at avoiding the effects of immune surveillance, which could contribute to HPV16's strong association with cervical cancer.
Strickler
Howard D
HD
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA. Strickle@aecom.yu.edu
Palefsky
Joel M
JM
Shah
Keerti V
KV
Anastos
Kathryn
K
Klein
Robert S
RS
Minkoff
Howard
H
Duerr
Ann
A
Massad
L Stewart
LS
Celentano
David D
DD
Hall
Charles
C
Fazzari
Melissa
M
Cu-Uvin
Susan
S
Bacon
Melanie
M
Schuman
Paula
P
Levine
Alexandra M
AM
Durante
Amanda J
AJ
Gange
Stephen
S
Melnick
Sandra
S
Burk
Robert D
RD
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology* / Q000821:virology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D015331:Cohort Studies; D015344:DNA Probes, HPV; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000276:immunology* / Q000821:virology; D006801:Humans; D015994:Incidence; D018655:Lymphocyte Count; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000276:immunology* / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014412:Tumor Virus Infections / Q000276:immunology* / Q000821:virology
D015344:DNA Probes, HPV; D004279:DNA, Viral