title: The Need for Cervical Cancer Control in HIV-Positive and HIV-Negative Women from Romania by Primary Prevention and by Early Detection Using Clinically Validated HPV/DNA Tests.
abstract: BACKGROUND
  In Romania, a country with no organized national surveillance program regarding cervical cancer, the early diagnosis of HPV (Human Papilloma Virus) infections is a major requirement, especially in HIV-infected women. The objective of this study was to determine the HPV prevalence and type distribution in young HIV-positive women and to assess the difference in the risk factors for developing cervical cancer compared to those of HIV-negative women.
  
  
  METHODS
  We conducted one cross-sectional cohort study from June 2013-September 2014, including 1,032 women: 992 HIV- women who were 36.5 years old (limits: 17 ÷ 84) and 40 HIV + women who were 22.9 years old (limits: 17 ÷ 30) with iatrogenic HIV infected. We detected HPV types with the Linear Array HPV Genotyping test (Roche, Romania).
  
  
  RESULTS
  DNA/HPV was detected in 18/40 (45%) of the HIV+ patients and in 350/992 (35.2%) of the HIV- patients (OR = 1.5, 95%CI 0.76÷2.96). After age adjustment, the overall HPV prevalence was 51.6% in HIV+ versus 63.2% in HIV- women aged under 25, and 22.2% in HPV+ versus 47.2% in HIV- women aged 25-34. We detect HIV being a risk factor for acquiring multiple HPV type infections (OR = 2.30, 95% CI 0.88÷5.97). The eight most common HPV types (high-risk, and low-risk) for women below age 30, HIV+ / - were: HPV 16, 18, 31, 51, 58, 68, and 6 and 82 respectively. To assess the risk factors of HIV-positive women for acquiring HPV infection, we analyzed the CD4/μL, ARN/HIV copies/μL, the age group, the number of sexual partners, smoking, and the type of HPV infection (single versus multiple infections). We found that the number of sexual partners and smoking are statistically significant risk factors.
  
  
  CONCLUSIONS
  Even though there are no significant differences regarding the prevalence of HPV infection in HIV + versus HIV - patients, multiple infections were more frequent in the first group. In our study group young HIV-infected patients under HAART therapy, high number of sexual partners (more than 3) and smoking were detected to be risk factors. Future organized screening for HPV infection using sensitive and specific methods are necessary at the national level in Romania.
authors.affiliation: Department of Microbiology, University of Medicine and Pharmacy "Gr. T. Popa", Iaşi, Romania.
authors.forename: Ramona Gabriela
authors.initials: RG
authors.lastname: Ursu
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr.T.Popa", Iasi, Romania, "Cuza Voda" Obstetrics and Gynecology Hospital, Iasi, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Onofriescu
authors.affiliation: "Cuza Voda" Obstetrics and Gynecology Hospital, Iasi, Romania.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Luca
authors.affiliation: Infectious Disease "St. Parascheva" Clinical University Hospital Iaşi, Iaşi, Romania.
authors.forename: Liviu Jany
authors.initials: LJ
authors.lastname: Prisecariu
authors.affiliation: Clinical Hospital "Căi Ferate" Iaşi, Iaşi, Romania.
authors.forename: Silvia Olivia
authors.initials: SO
authors.lastname: Sălceanu
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr.T.Popa", Iasi, Romania, "Cuza Voda" Obstetrics and Gynecology Hospital, Iasi, Romania.
authors.forename: Dragoş
authors.initials: D
authors.lastname: Nemescu
authors.affiliation: Department of Microbiology, University of Medicine and Pharmacy "Gr. T. Popa", Iaşi, Romania.
authors.forename: Luminiţa Smaranda
authors.initials: LS
authors.lastname: Iancu
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000821:virology*; D061809:Human Papillomavirus DNA Tests / Q000379:methods*; D006801:Humans; D011322:Primary Prevention; D015203:Reproducibility of Results; D012383:Romania; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology*; D055815:Young Adult