title: Sustained viral suppression and higher CD4+ T-cell count reduces the risk of persistent cervical high-risk human papillomavirus infection in HIV-positive women.
abstract: BACKGROUND
  Studies analyzing the impact of combination antiretroviral therapy (cART) on cervical infection with high-risk human papillomavirus (HR-HPV) have generated conflicting results. We assessed the long-term impact of cART on persistent cervical HR-HPV infection in a very large cohort of 652 women who underwent follow-up of HIV infection for a median duration of 104 months.
  
  
  METHODS
  Prospective cohort of HIV-infected women undergoing HIV infection follow-up who had HR-HPV screening and cytology by Papanicolaou smear performed yearly between 2002 and 2011.
  
  
  RESULTS
  At baseline, the median age was 38 years, the race/ethnic origin was sub-Sarahan Africa for 84%, the median CD4(+) T-cell count was 426 cells/µL, 79% were receiving cART, and the HR-HPV prevalence was 43%. The median interval of having had an HIV load of <50 copies/mL was 40.6 months at the time of a HR-HPV-negative test result, compared with 17 months at the time of a HR-HPV-positive test result (P < .0001, by univariate analysis). The median interval of having had a CD4(+) T-cell count of >500 cells/µL was 18.4 months at the time of a HR-HPV-negative test result, compared with 4.45 months at the time of a HR-HPV-positive test result (P < .0001). In multivariate analysis, having had an HIV load of <50 copies/mL for >40 months (odds ratio [OR], 0.81; 95% confidence interval [CI], .76-.86; P < .0001) and having had a CD4(+) T-cell count of >500 cells/µL for >18 months (OR, 0.88; 95% CI, .82-.94; P = .0002) were associated with a significantly decreased risk of HR-HPV infection.
  
  
  CONCLUSIONS
  Sustained HIV suppression for >40 months and a sustained CD4(+) T-cell count of >500 cells/µL for >18 months are independently and significantly associated with a decreased risk of persistent cervical HR-HPV infection.
authors: Department of Infectious Diseases and AIDS Reference Center, Saint-Pierre University Hospital, rue Haute 322, Brussels 1000, 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; D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents