The impact of HIV status and type on the clearance of human papillomavirus infection among Senegalese women.
BACKGROUND
Persistent infection with human papillomavirus (HPV) is associated with the development and progression of HPV-related disease, including cervical intraepithelial neoplasia (CIN) and invasive cervical cancer.


METHODS
We examined the impact of human immunodeficiency virus (HIV) status and type on the clearance of HPV infection among 614 Senegalese women enrolled in a longitudinal study of HPV and CIN. Women were examined every 4 months for HPV DNA. Clearance was defined as 2 consecutive negative HPV DNA test results.


RESULTS
Cox proportional hazard regression with time-dependent covariates indicated that HIV-positive women were less likely to clear HPV infection (adjusted hazard ratio [HR], 0.31 [95% confidence interval {CI}, 0.21-0.45]) than HIV-negative women. Among HIV-positive women, those with CD4 cell counts <200 or from 200 to 500 cells/microL showed a 71% (adjusted HR, 0.29 [95% CI, 0.11-0.76]) and 32% (adjusted HR, 0.68 [95% CI, 0.31-1.48]) reduction in the likelihood of HPV clearance, respectively, compared with those with CD4 cell counts >500 cells/microL. HIV-2 infection was associated with an increased likelihood of HPV clearance (adjusted HR, 2.46 [95% CI, 1.17-5.16]), compared with that for HIV-1 infection.


CONCLUSIONS
HIV infection reduces the likelihood of HPV clearance. Among HIV-positive women, immunosuppression, as measured by CD4 cell count, reduces the likelihood of HPV clearance, and HIV type appears to be associated with HPV clearance.
Rowhani-Rahbar
Ali
A
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98103, USA.
Hawes
Stephen E
SE
Sow
Papa Salif
PS
Toure
Papa
P
Feng
Qinghua
Q
Dem
Ahmadou
A
Dembele
Birama
B
Critchlow
Cathy W
CW
N'Doye
Ibraham
I
Kiviat
Nancy B
NB
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000302:isolation & purification*; D015498:HIV-2 / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000276:immunology*; D012675:Senegal; D014930:Women
D004279:DNA, Viral