title: High-risk human papillomavirus in HIV-infected women undergoing cervical cancer screening in Lilongwe, Malawi: a pilot study.
abstract: Rates of abnormal visual inspection with acetic acid and prevalence of high-risk human papillomavirus (HPV) subtypes have not been well characterized in HIV-infected women in Malawi. We performed a prospective cohort study of visual inspection with acetic acid (N = 440) in HIV-infected women aged 25--59 years, with a nested study of HPV subtypes in first 300 women enrolled. Of 440 women screened, 9.5% (N = 42) had abnormal visual inspection with acetic acid with 69.0% (N = 29) having advanced disease not amenable to cryotherapy. Of 294 women with HPV results, 39% (N = 114) of women were positive for high-risk HPV infection. Only lower CD4 count (287 cells/mm(3) versus 339 cells/mm(3), p = 0.03) and high-risk HPV (66.7% versus 35.6%, p < 0.01) were associated with abnormal visual inspection with acetic acid. The most common high-risk HPV subtypes in women with abnormal visual inspection with acetic acid were 35 (33.3%), 16 (26.7%), and 58 (23.3%). Low CD4 cell count was associated with abnormal visual inspection with acetic acid and raises the importance of early antiretroviral therapy and expanded availability of visual inspection with acetic acid. HPV vaccines targeting additional non-16/18 high-risk HPV subtypes may have greater protective advantages in countries such as Malawi.
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles, Center for Clinical AIDS Research and Education and the UCLA AIDS Institute, Los Angeles, CA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Reddy
authors.affiliation: International Training and Education Centre on Health (I-TECH), Lilongwe, Malawi.
authors.forename: Joseph
authors.initials: J
authors.lastname: Njala
authors.affiliation: Partners in Hope, Lilongwe, Malawi.
authors.forename: Penny
authors.initials: P
authors.lastname: Stocker
authors.affiliation: Partners in Hope, Lilongwe, Malawi David Geffen School of Medicine at the University of California, Los Angeles, Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Schooley
authors.affiliation: Department of Biostatistics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
authors.forename: Martiniano
authors.initials: M
authors.lastname: Flores
authors.affiliation: Department of Biostatistics, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Partners in Hope, Lilongwe, Malawi David Geffen School of Medicine at the University of California, Los Angeles, Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: Pfaff
authors.affiliation: Partners in Hope, Lilongwe, Malawi.
authors.forename: Perry
authors.initials: P
authors.lastname: Jansen
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles, Center for Clinical AIDS Research and Education and the UCLA AIDS Institute, Los Angeles, CA, USA.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Mitsuyasu
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles, Center for Clinical AIDS Research and Education and the UCLA AIDS Institute, Los Angeles, CA, USA David Geffen School of Medicine at the University of California, Los Angeles, Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA rhoffman@mednet.ucla.edu.
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
mesh_terms: D019342:Acetic Acid; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000821:virology
chemical_list: D004279:DNA, Viral; D019342:Acetic Acid
keywords: Africa; HIV/AIDS; cervical cancer; cervical intraepithelial neoplasia; high-risk HPV; human papillomavirus; sexually transmitted infection; visual inspection with acetic acid; women