title: Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women.
abstract: BACKGROUND
  HIV-seropositive women face high risk for infection with oncogenic human papillomavirus (oncHPV) types, abnormal Pap test results, and precancer, but cervical cancer risk is only modestly increased. Human papillomavirus (HPV)16 is highly oncogenic but only weakly associated with HIV status and immunosuppression, suggesting HPV16 may have a greater innate ability to evade host immune surveillance than other oncHPV types, which in turn should result in a greater relative increase in the prevalence of other oncHPV types among women with cervical precancer.
  
  
  OBJECTIVE
  We sought to assess whether the underrepresentation of HPV16 among HIV-seropositive relative to HIV-seronegative women remains among those with cervical precancers.
  
  
  METHODS
  HIV-seropositive and HIV-seronegative women in the Women's Interagency HIV Study were screened for cervical intraepithelial neoplasia (CIN) grade ≥3 (CIN3(+)). DNA from >40 HPV types was detected by polymerase chain reaction in cervicovaginal lavage specimens obtained at the visit at which CIN3(+) was diagnosed.
  
  
  RESULTS
  HPV16 was detected in 13 (62%) of 21 HIV-seronegative women with CIN3(+) but only 44 (29%) of 154 HIV-seropositive women with CIN3(+) (P = .01). The lower prevalence of HPV16 in CIN3(+) among HIV-seropositive women persisted after controlling for covariates (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08-0.78). The prevalence of other members of the HPV16-related alpha-9 oncHPV clade as a group was similar in HIV-infected and uninfected women with CIN3(+) (OR, 1.02; 95% CI, 0.53-1.94). The prevalence of non-alpha-9 oncHPV types was increased in HIV-seropositive vs HIV-seronegative women with CIN3(+) (OR, 3.9; 95% CI, 1.3-11.8).
  
  
  CONCLUSIONS
  The previously demonstrated increase in CIN3(+) incidence among HIV-seropositive women is associated with lower HPV16 and higher non-alpha-9 oncHPV prevalence. This is consistent with prior reports that HIV has a weak effect on infection by HPV16 relative to other oncHPV and supports use of nonavalent HPV vaccine in HIV-seropositive women.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO. Electronic address: massadl@wudosis.wustl.edu.
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.affiliation: Albert Einstein College of Medicine, New York, NY.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Xie
authors.affiliation: Albert Einstein College of Medicine, New York, NY.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Department of Pathology and of Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.affiliation: Department of Maimonides Medical Center, New York, NY.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Department of Georgetown University, Washington, DC.
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.affiliation: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Burian
authors.affiliation: Department of Pathology and of Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Joel
authors.initials: J
authors.lastname: Palefsky
authors.affiliation: Albert Einstein College of Medicine, New York, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Atrio
authors.affiliation: Albert Einstein College of Medicine, New York, NY.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
mesh_terms: D000328:Adult; D000368:Aged; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000821:virology*
keywords: HIV in women; cervical intraepithelial neoplasia; human papillomavirus; viral oncogenesis