title: The diversity of human papillomavirus infection among human immunodeficiency virus-infected women in Yunnan, China.
abstract: BACKGROUND
  Yunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China. We conducted an observational study to evaluate the human papillomavirus (HPV) genotype distribution in relation to cervical neoplastic disease risk among HIV-infected women in Yunnan.
  
  
  METHODS
  We screened 301 HIV-infected non-pregnant women in Mangshi prefecture in Yunnan province. All consenting participants underwent simultaneous and independent assessment by cervical cytology, colposcopy-histopathology, and HPV genotyping. Unadjusted and multivariable-adjusted multinomial logistic regression analysis was conducted to evaluate factors associated with single or multiple carcinogenic HPV genotypes.
  
  
  RESULTS
  HPV genotypes were present in 43.5% (131/301) overall, and carcinogenic HPV genotypes were present in 37.5% (113/301) women. Among women with carcinogenic HPV genotypes, 80 (70.8% of 113) had a single carcinogenic HPV type, while 33 (29.2%) women had multiple (2 or more) carcinogenic HPV types. Overall, the most common carcinogenic HPV types were HPV52 (7.3%), HPV58 (6.6%), HPV18 (6.3%), HPV16 (6.0%), and HPV33 (5.3%). In women with cervical precancerous lesions (i.e., high-grade squamous intraepithelial lesions [HSIL] on cytology or cervical intraepithelial neoplasia grade 2 or worse [CIN2+] detected on colposcopy-histology), the most commonly detected genotypes were HPV16 (28.6%), HPV52 (25.0%), HPV58 (17.9%), HPV18 (10.7%) and HPV31 (10.7%). Increasing age was an independent risk factor associated with presence of single carcinogenic HPV types (adjusted odds ratio: 1.04, 95%CI: 1.01-1.07, p = 0.012) but not with the presence of multiple carcinogenic types in the multivariable-adjusted models.
  
  
  CONCLUSIONS
  As HIV-infected women continue to live longer on antiretroviral therapy in China, it will be increasingly important to screen for, and prevent, HPV-associated cervical cancer in this population, especially given the wide diversity and multiplicity of HPV genotypes.
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. 13888750195@163.com.
authors.forename: Hong-Yun
authors.initials: HY
authors.lastname: Zhang
authors.affiliation: Centre for Disease Control and Prevention of Yunnan Province, Yunnan, China. feimandong@qq.com.
authors.forename: Man-Dong
authors.initials: MD
authors.lastname: Fei
authors.affiliation: Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. jiangyong@cicams.ac.cn.
authors.forename: Yong
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. lisa19871003@aliyun.com.
authors.forename: Qiu-Yue
authors.initials: QY
authors.lastname: Fei
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. huxingran@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Qian
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. xulin64@163.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. jinyuni@yahoo.cn.
authors.forename: Yu-Ni
authors.initials: YN
authors.lastname: Jin
authors.affiliation: Women and Children's Hospital of Luxi County, Luxi, Yunnan, China. jiangchengqin666@163.com.
authors.forename: Cheng-Qin
authors.initials: CQ
authors.lastname: Jiang
authors.affiliation: Women and Children's Hospital of Luxi County, Luxi, Yunnan, China. ybhdctggg@163.com.
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Li
authors.affiliation: Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. sarah.tiggelaar@fmed.isu.edu.|Vanderbilt University, Nashville, TN, USA. sarah.tiggelaar@fmed.isu.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Tiggelaar
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. jsssmith@email.unc.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Vanderbilt University, Nashville, TN, USA. vikrant.sahasrabuddhe@vanderbilt.edu.
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.affiliation: Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. qiaoy@cicams.ac.cn.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology*; D015995:Prevalence