HIV/HPV co-infection during pregnancy in southeastern Brazil: prevalence, HPV types, cytological abnormalities and risk factors.
OBJECTIVE
HIV(+) pregnant women are at a higher risk of HPV infection and development of cervical cancer. Our objectives were to assess the prevalence and HPV types in HIV(+) pregnant women and to identify risk factors for HPV infection and cytological abnormalities.


METHODS
Cervicovaginal smears were collected during pregnancy from 140 women. Partial HPV L1 gene and the exon 4 of the human TP53 gene (containing codon 72) were PCR-amplified and sequenced. Amplified products indicating multiple HPV infection were further cloned and sequenced. The association of demographic, obstetric and HIV-related clinical variables with HPV infection and cervical lesions was tested by univariate analyses, and significant factors were subsequently tested by logistic regression multivariate analysis.


RESULTS
HPV DNA tested positive for 118 patients and HPV types were identified in 104 samples. Twenty-eight different types were found, HPV-16 and HPV-58 being the most prevalent. High-risk types were present in 79.8% of samples and multiple infections in 16.3%. Abnormal cervical smears were found in 44 patients (31.4%). Absolute CD4(+) T-cell counts below 350 were associated with HPV infection. Younger age was associated with cervical abnormalities and higher CD4(+) T-cell count was an apparent protective factor.


CONCLUSIONS
We found a high prevalence of HPV infection and high-risk types in this cohort. Our results highlighted the relevance of immune system integrity rather than TP53 variants for protecting this highly vulnerable population to HPV infection and carcinogenesis.
Instituto de Ginecologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Programa de Pós Graduação em Ciências Cirúrgicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Angela R I
ARI
Meyrelles
Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Juliana D
JD
Siqueira
Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cristina B
CB
Hofer
Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Tomaz P
TP
Costa
Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Andrea P
AP
Azevedo
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Bruna V
BV
Guimarães
Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Héctor N
HN
Seuánez
Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Marcelo A
MA
Soares
Instituto de Ginecologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Programa de Pós Graduação em Ciências Cirúrgicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Gutemberg
G
Almeida
Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Esmeralda A
EA
Soares
Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: emachado@infolink.com.br.
Elizabeth S
ES
Machado
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000473:pathology*; D060085:Coinfection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D006801:Humans; D027383:Papillomaviridae / Q000145:classification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014626:Vaginal Smears