title: HPV infection in HIV-positive females: the need for cervical cancer screening including HPV-DNA detection despite successful HAART.
abstract: OBJECTIVE
  To identify the presence of Human Papilloma Virus (HPV) infection and evaluate the role of Highly Active Antiretroviral Treatment (HAART) in patients with HIV-HPV co-infection. We also compared cytological screening results with HPV-DNA detection to implement screening programs and prevention of invasive cervical cancer (ICC) in HIV-infected females.
  
  
  METHODS
  We enrolled HIV-infected females presenting for routine clinical evaluation. HPV-DNA of high/intermediate and low-risk types was detected from cervical specimens by nucleic acid hybridization assay with signal-amplification. Patients were divided into two groups according to the presence of HPV co-infection (HPV+) or not (HPV-).
  
  
  RESULTS
  We enrolled 57 HIV-infected females. Median age was 40 (IQR 35-44) years, mean CD4 count was 547 ± 227 cells/mm(3), 45 (78.9%) had undetectable HIV-RNA and 52 (91.2%) received HAART. Globally, 19/57 (33.3%) patients were HPV-infected, 16/57 (28.1%) with high/intermediate and 3/57 (5.3%) with low-risk types. Five of the 19 (26.3%) HPV+ patients carried both types. Correlating high-risk genotype HPV-DNA detection with cytology, 17.5% of women with negative cytology, 36.4% with ASCUS (Atypical Squamous Cells of Uncertain Significance) and 83.4% of women with positive cytology (50% of LSIL: low-grade squamous intraepithelial lesion and 100% of HSIL: high grade SIL) were HPV positive. No statistical difference when comparing HPV+ and HPV-patients in age, CD4 cell count, in the proportion of previous intravenous-drug use, previous AIDS and of those receiving HAART with undetectable HIV-RNA was observed.
  
  
  CONCLUSIONS
  Cervical cancer screening including HPV-DNA detection should be implemented in HIV infected females across Europe, also when receiving successful HAART, to early identify the HIV patients at risk for ICC to be submitted to more frequent follow up and proper treatment.
authors.affiliation: Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Italy. giordano.madeddu@uniss.it.
authors.forename: G
authors.initials: G
authors.lastname: Madeddu
authors.forename: G
authors.initials: G
authors.lastname: Mameli
authors.forename: G
authors.initials: G
authors.lastname: Capobianco
authors.forename: S
authors.initials: S
authors.lastname: Babudieri
authors.forename: I
authors.initials: I
authors.lastname: Maida
authors.forename: P
authors.initials: P
authors.lastname: Bagella
authors.forename: G
authors.initials: G
authors.lastname: Rocca
authors.forename: P L
authors.initials: PL
authors.lastname: Cherchi
authors.forename: L A
authors.initials: LA
authors.lastname: Sechi
authors.forename: S
authors.initials: S
authors.lastname: Zanetti
authors.forename: G
authors.initials: G
authors.lastname: Nunnari
authors.forename: S
authors.initials: S
authors.lastname: Dessole
authors.forename: M S
authors.initials: MS
authors.lastname: Mura
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003581:Cytodiagnosis; D004279:DNA, Viral / Q000235:genetics*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral