title: Cervical cytological abnormalities and HPV infection in perinatally HIV-infected adolescents.
abstract: BACKGROUND
  Behaviourally HIV-infected adolescent females are at higher risk for abnormal cervical cytology and HPV infection compared to those who are uninfected, but data on perinatally HIV-infected adolescent females are lacking.
  
  
  METHODS
  Cervical cytology, HPV infection and E6/E7 mRNA were assessed in sexually active 12-24-year-old adolescent females: perinatally HIV-infected (group 1,n= 40), behaviourally HIV-infected (group 2,n= 10), and HIV-uninfected (group 3,n= 10).
  
  
  RESULTS
  Median age was lower in group 1 (18 years) than in groups 2 (24 years) and 3 (20.5 years) (P< 0.001), and median time since sexual debut was shorter: 2 vs 5 vs 4 years (P< 0.001). More trial participants in group 1 than group 2 were on antiretrovirals (90% vs 70%;P<0.001). Abnormal cervical cytology (atypical squamous cells of undetermined significance and higher) was observed in 30% (group 1), 40% (group 2) and 30% (group 3) (P= 0.92), whereas high-risk HPV infection was observed in 45%, 45% and 40%, respectively (P= 1.00). Positive E6/E7 mRNA was found in 28% of group 1, but not in other groups. High-risk HPV infection predicted abnormal cytology in all groups [OR 6.77, 95% confidence interval (CI) 1.99-23.0;P= 0.001). Additionally, plasma HIV RNA ≥50 copies/mL (OR 13.3, 95% CI 1.16-153.06;P= 0.04) predicted abnormal cytology in HIV-infected adolescent females.
  
  
  CONCLUSIONS
  Despite the younger age and shorter time since sexual debut, cervical cytological abnormalities and HPV infection were as common in perinatally HIV-infected as in behaviourally infected and uninfected adolescents. HPV vaccination, pre-cancer screening and antiretroviral treatment in HIV-infected female adolescents should be implemented to minimise the risk of cervical cancer.
authors.affiliation: HIV Netherland Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Ananworanich
authors.affiliation: Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Prasitsuebsai
authors.affiliation: SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: S J
authors.initials: SJ
authors.lastname: Kerr
authors.affiliation: Kirby Institute of Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Hansudewechakul
authors.affiliation: Chiangrai Prachanukroh Hospital, Chiangrai, Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Teeratakulpisarn
authors.affiliation: Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Saisawat
authors.affiliation: Petchburi Hospital, Petchburi, Thailand.
authors.forename: R
authors.initials: R
authors.lastname: Ramautarsing
authors.affiliation: Faculty of Medicine, Siriraj Hosptial, Mahidol University, Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Achalapong
authors.affiliation: TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Pussadee
authors.forename: S
authors.initials: S
authors.lastname: Keadpudsa
authors.forename: T
authors.initials: T
authors.lastname: Mackay
authors.forename: T
authors.initials: T
authors.lastname: Pankam
authors.forename: P
authors.initials: P
authors.lastname: Rodbamrung
authors.forename: W
authors.initials: W
authors.lastname: Petdachai
authors.forename: K
authors.initials: K
authors.lastname: Chokephaibulkit
authors.forename: A H
authors.initials: AH
authors.lastname: Sohn
authors.forename: N
authors.initials: N
authors.lastname: Phanuphak
keywords: HPV; Pap smear; adolescents; cervix; perinatal HIV