title: High-risk human papillomavirus infection in HIV-positive African women living in Europe.
abstract: BACKGROUND
  Cervical infection with high-risk human papillomavirus (HRHPV) induces cervical cancer and is present in 14% of women in Europe. We assessed the prevalence and incidence of cervical HRHPV in a cohort of HIV-positive women living in Belgium.
  
  
  METHODS
  Prospective observational program of screening and follow up of HRHPV cervical infection performed by Hybrid Capture in 825 HIV-positive women between 2002 and 2011. Women without normal cervix at baseline were excluded.
  
  
  RESULTS
  The final analysis included 652 women: median age 38 years, African origin (81%), median HIV follow-up (66 months), median CD4 count (426 cells/μL) and 79% on antiretroviral therapy (cART). At baseline, HRHPV prevalence was 43% and decreased significantly as both age and CD4 cell count increased: highest prevalence (100%) in women <30 years and <200 CD4/μL and lowest (19%) in women >40 years and >500 CD4/μL (p<0.0001, multivariate analysis). The relative risk (RR) to carry HRHPV at baseline decreases proportionally by 11% for each 5 years-age increase and by 11% for each 100 CD4 cells/μL rise (RR=0.89, 95% CI: 0.85-0.93; p<0.0001, Poisson regression for both). During follow-up, incidence rate of HRHPV was 13.4 per 100 women-years.
  
  
  CONCLUSIONS
  We found a high HRHPV prevalence of 43% and an incidence rate of 13 per 100 women-years in this cohort of HIV-positive women living in Europe and on cART. Women under 40 years-age had the highest prevalence even with CD4 count >350 cells/μL. The magnitude of HRHPV epidemiology should prompt to evaluate the clinical efficacy of vaccines against HPV in HIV-infected women.
authors: Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels Free University, Brussels, Belgium. deborah_konopnicki@stpierre-bru.be
authors: Deborah
authors: D
authors: Konopnicki
authors: Yannick
authors: Y
authors: Manigart
authors: Christine
authors: C
authors: Gilles
authors: Patricia
authors: P
authors: Barlow
authors: Jérome
authors: J
authors: de Marchin
authors: Francesco
authors: F
authors: Feoli
authors: Denis
authors: D
authors: Larsimont
authors: Marc
authors: M
authors: Delforge
authors: Stéphane
authors: S
authors: De Wit
authors: Nathan
authors: N
authors: Clumeck
mesh_terms: D000328:Adult; D000367:Age Factors; D001530:Belgium / Q000453:epidemiology; D002584:Cervix Uteri / Q000821:virology; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology*; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
keywords: CD4 cell count; Europe; HIV; HPV; cervix; incidence; prevalence; women