Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa.
OBJECTIVE
To examine the association between CD4 counts, HPV infection and the risk of cervical neoplasia among HIV-seropositive women.


METHODS
A cross-sectional observational study was conducted among 1,010 HIV-seropositive women using cytology-based Pap smears. HPV DNA testing using Linear Array genotyping assay (Roche) was carried out in a subset of 191 patients. Multivariable-adjusted prevalence ratios (mPR) and 95% confidence intervals (CIs) were estimated with log-binomial regression.


RESULTS
Among 1,010 HIV-seropositive women, the prevalence of AGC/ASCUS, LSIL and HSIL or greater was 8.3, 23.5 and 18.0%, respectively. The risk of cervical lesions was higher with CD4 < 200 cells/mm(3) vs. CD4 levels > 500/mm(3). HPV types 16 (41.7%) and HPV 56 (22.2%) were the most common types in HSIL cases. Women with CD4 levels < 200/mm(3) had a higher prevalence of HPV types 16 (p < 0.01) and 66 (p = 0.04). No statistical relationship between cervical lesions and HAART use was found.


CONCLUSIONS
The burden of HPV infection and HSIL was high and correlated with HIV-induced immunosuppression. HPV 16 was the most common type in HSIL and increased in prevalence with greater immune suppression. Prophylactic HPV 16 vaccination could prevent approximately 40% of HSIL cases. Strengthening screening programs is imperative in this population.
Firnhaber
Cynthia
C
Department of Medicine, University of Witwatersrand, Johannesburg, South Africa. cfirnhaber@witshealth.co.za
Van Le
Hoa
H
Pettifor
Audrey
A
Schulze
Doreen
D
Michelow
Pam
P
Sanne
Ian M
IM
Lewis
David A
DA
Williamson
Anna-Lise
AL
Allan
Bruce
B
Williams
Sophia
S
Rinas
Allen
A
Levin
Simon
S
Smith
Jennifer S
JS
D000328:Adult; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000821:virology; D006304:Health Status; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D011230:Precancerous Conditions / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000821:virology; D016387:Women's Health; D055815:Young Adult