title: Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy.
abstract: BACKGROUND
  Natural history of HPV infection is altered in HIV positive women, with increased risk of cervical dysplasia. Limited data are available about the influence of HPV genotypes and HPV multiple infections on cervical disease in HIV positive women.
  
  
  OBJECTIVE
  We determined HPV genotype prevalence in cervical samples from 553 HIV-infected women attending the gynaecological service at "L. Spallanzani" Hospital. Association of HPV multiple infections with cervical abnormalities was investigated.
  
  
  METHODS
  MY09/MY11 consensus primers were used to detect HPV-DNA; HPV typing was performed by RFLP. A commercial array based kit was used to define unresolved RFLP patterns.
  
  
  RESULTS
  HPV was detected in 244/553 (44.1%) patients, correlating with low CD4 counts (p<0.001) and age (p=0.001). Multiple HPV types were observed in 44.4% of cases, more frequently involving HR than LR HPV (OR=12.8, p<0.00001). Multiple HPV infections were associated with low CD4 counts (OR=3.8 in CD4<200 vs CD4≥500 cells/mm(3)). Dyskaryosis was associated with decreased CD4 counts (≥500 vs 200-499 vs <200 cells/mm(3), χ(2) for trend, p=0.001) and with HPV types multiplicity (1 vs 2-3 vs ≥4, χ(2) for trend, p<0.00001). Notably, in 3 H-SIL cases only LR types were detected (HPV62, n=2; HPV81, n=1).
  
  
  CONCLUSIONS
  Multiple HPV infections, often involving HR types, are frequent in HIV-infected women. Association between multiple HPV infection, low CD4 count and cytological abnormalities supports the interplay of virological and immunological factors in cervical cancer pathogenesis. Assessment of multiple HPV infections might gain importance in cervical cancer screening, particularly in patients with predisposing factors like immuno-suppression.
authors.affiliation: Laboratory of Virology, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy.
authors.forename: Anna Rosa
authors.initials: AR
authors.lastname: Garbuglia
authors.forename: Pierluca
authors.initials: P
authors.lastname: Piselli
authors.forename: Daniele
authors.initials: D
authors.lastname: Lapa
authors.forename: Catia
authors.initials: C
authors.lastname: Sias
authors.forename: Franca
authors.initials: F
authors.lastname: Del Nonno
authors.forename: Andrea
authors.initials: A
authors.lastname: Baiocchini
authors.forename: Claudia
authors.initials: C
authors.lastname: Cimaglia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agresta
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Capobianchi
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000821:virology; D060085:Coinfection / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D017931:DNA Primers / Q000235:genetics; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D017931:DNA Primers; D004279:DNA, Viral