title: A cross-sectional study of high-risk human papillomavirus clustering and cervical outcomes in HIV-infected women in Rio de Janeiro, Brazil.
abstract: BACKGROUND
  In Brazil, the rate of cervical cancer remains high despite the availability of screening programs. With ongoing vaccine development and implementation, information on the prevalence of specific HPV types is needed, particularly among high-risk populations, such as HIV-infected women.
  
  
  METHODS
  We performed a study of HIV-infected women in Rio de Janeiro, Brazil, who underwent cervical HPV genotype testing between 2005-2013. We examined the prevalence of high-risk HPV types and the patterns of high-risk HPV type clustering. Using logarithmic binomial regression, we estimated the risk of abnormal cytology by HPV genotype result.
  
  
  RESULTS
  Of the 562 women included, 498 (89 %) had at least one HPV type detected. 364 women (65 %) had at least one high-risk HPV type detected and 181 (32 %) had more than one high-risk type detected. HPV 58 was the most frequent HPV type detected overall (prevalence 19.8 % [95 % confidence interval 16.4-23.1]), followed by HPV 53 (prevalence 15.5 % [12.5-18.5]) and HPV 16 (prevalence 13 % [10.2-15.8]). Women infected with more than one high-risk HPV type were younger, had lower CD4+ lymphocyte counts, and were more likely to be infected with HPV 16 or 18. In adjusted analyses, presence of more than one high-risk HPV type was associated with a two-fold increased risk of abnormal cytology after adjusting for presence of individual high-risk type, age, and CD4+ lymphocyte count (adjusted prevalence ratios 1.88-2.07, all p <0.001). No single high-risk HPV type was statistically associated with abnormal cytology after adjusting for the presence of more than one high-risk HPV type.
  
  
  CONCLUSIONS
  In the largest study of cervical HPV genotypes among HIV-infected women in Latin America, infection by high-risk HPV types other than 16 or 18 and infection by more than one high-risk HPV types were common. Infection by more than one high-risk type was more strongly associated with abnormal cervical cytology than any individual high-risk HPV type, highlighting the need for multi-valent HPV vaccines.
authors.affiliation: Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, USA. jessica.castilho@vanderbilt.edu.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Castilho
authors.affiliation: Virology Lab, Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil. dudilevi@usp.br.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Levi
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. luzpaulamendes@gmail.com.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
authors.affiliation: Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, USA. mcambou@mednet.ucla.edu.
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Cambou
authors.affiliation: Departamento de Ciência e Tecnologia, Ministério da Saúde, Brasília, Brazil. vannit@fellows.iarc.fr.
authors.forename: Tazio
authors.initials: T
authors.lastname: Vanni
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. angela.andrade@ipec.fiocruz.br.
authors.forename: Angela
authors.initials: A
authors.lastname: de Andrade
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. monica.derrico@gmail.com.
authors.forename: Mônica
authors.initials: M
authors.lastname: Derrico
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. valdilea.veloso@gmail.com.
authors.forename: Valdiléa G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. beatriz.grinsztejn@gmail.com.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. ruthkf@gmail.com.
authors.forename: Ruth K
authors.initials: RK
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000821:virology