Prevalence and risk factors for human papillomavirus and cervical intraepithelial neoplasia among HIV-positive women at a tertiary level hospital in India.
OBJECTIVE
The hypothesis to be tested was that the prevalence of human papillomavirus (HPV) and cervical intraepithelial neoplasia would be significantly higher in HIV seropositive women as compared with seronegative controls. Secondary aims were to determine the risk factors for HPV and cervical intraepithelial neoplasia and the HPV types in HIV-positive women.


METHODS
A cross-sectional study of women 18 to 49 years old was done. Seventy-five women who were HIV seropositive and 58 seronegative women, of whom 27 had HIV-positive partners, participated in the study. A Pap smear and a cervical swab for HPV were done. Women with Pap smear abnormality underwent colposcopy and large loop excision procedures if indicated.


RESULTS
Ten (13.3%) HIV-positive women had high-grade squamous intraepithelial lesion as compared with 2 (3.4%) seronegative women (odds ratio [OR] 4.3; 95% CI = 0.9-41.7; p =.048). Among the HIV-positive women, 28 (37.3%) had high-risk HPV, whereas only 9 (15.5%) had high-risk HPV among seronegative women (OR 3.2; 95% CI = 1.3-8.3; p =.009). Among women who were positive for high-risk HPV, the HIV-positive women were significantly more likely to have more than 1 HPV type (OR 7.4; 95% CI = 1.4-43.7; p =.005). Women who had coitus at less than 18 years of age were more likely to have high-risk HPV infection (OR 2.9; 95% CI = 1.2-6.2; p =.013) even after controlling for HIV status.


CONCLUSIONS
HIV-positive women have a higher risk for multiple HPV infections as compared with seronegative women. Behavioral factors dominate HIV in determining HPV infections and resultant cervical neoplasia.
Peedicayil
Abraham
A
Department of Obstetrics & Gynaecology, Christian Medical College, Vellore, Tamilnadu, India. abraham@cmcvellore.ac.in
Thiyagarajan
Kamala
K
Gnanamony
Manu
M
Pulimood
Susanne A
SA
Jeyaseelan
Visali
V
Kannangai
Rajesh
R
Lionel
Jessie
J
Abraham
Oopurackal C
OC
Abraham
Priya
P
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015483:HIV Antibodies / Q000276:immunology*; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D027383:Papillomaviridae / Q000276:immunology*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology* / Q000821:virology
D015483:HIV Antibodies