title: Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa.
abstract: 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.
authors: Department of Medicine, University of Witwatersrand, Johannesburg, South Africa. cfirnhaber@witshealth.co.za
authors: Cynthia
authors: C
authors: Firnhaber
authors: Hoa
authors: H
authors: Van Le
authors: Audrey
authors: A
authors: Pettifor
authors: Doreen
authors: D
authors: Schulze
authors: Pam
authors: P
authors: Michelow
authors: Ian M
authors: IM
authors: Sanne
authors: David A
authors: DA
authors: Lewis
authors: Anna-Lise
authors: AL
authors: Williamson
authors: Bruce
authors: B
authors: Allan
authors: Sophia
authors: S
authors: Williams
authors: Allen
authors: A
authors: Rinas
authors: Simon
authors: S
authors: Levin
authors: Jennifer S
authors: JS
authors: Smith
mesh_terms: 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