Genital tract HIV RNA levels and their associations with human papillomavirus infection and risk of cervical precancer.
OBJECTIVE
Plasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia.


METHODS
In an HIV-seropositive women's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident high-grade squamous intraepithelial lesions (HSIL) subclassified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incidents of severe HSIL were matched to 130 controls by age, CD4 count, highly active antiretroviral therapy use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects.


RESULTS
Risk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable, 2.96; 95% confidence interval: 0.99 to 8.84; Ptrend = 0.03). However, this association became nonsignificant (Ptrend = 0.51) after adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend = 0.02) and persistence of oncogenic HPV (Ptrend = 0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels.


CONCLUSIONS
These prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical precancer in HIV-seropositive women, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.
*Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY; †Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, NY; ‡Department of Pediatrics, University of Southern California, Los Angeles, CA; §Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; ‖Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO; ¶Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; #Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; **Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; ††Department of Health and Human Services, National Institute of Child Health and Human Development, Bethesda, MD; ‡‡Department of Hematology, City of Hope National Medical Center, Duarte, CA; §§Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, DC; ‖‖Department of Pathology, University of Alabama, Birmingham, AL; and ¶¶Department of Medicine, University of California, San Francisco, CA.
Jeny
J
Ghartey
Andrea
A
Kovacs
Robert D
RD
Burk
L
L
Stewart Massad
Howard
H
Minkoff
Xianhong
X
Xie
Gypsyamber
G
Dʼsouza
Xiaonan
X
Xue
D
D
Heather Watts
Alexandra M
AM
Levine
Mark H
MH
Einstein
Christine
C
Colie
Kathryn
K
Anastos
Isam-Eldin
IE
Eltoum
Betsy C
BC
Herold
Joel M
JM
Palefsky
Howard D
HD
Strickler
D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology*; D011230:Precancerous Conditions / Q000821:virology*; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000821:virology*; D014621:Vagina / Q000821:virology*
D004279:DNA, Viral; D012367:RNA, Viral