title: Bonafide, type-specific human papillomavirus persistence among HIV-positive pregnant women: predictive value for cytological abnormalities, a longitudinal cohort study.
abstract: This study investigated the rate of human papillomavirus (HPV) persistence, associated risk factors, and predictors of cytological alteration outcomes in a cohort of human immunodeficiency virus-infected pregnant women over an 18-month period. HPV was typed through L1 gene sequencing in cervical smears collected during gestation and at 12 months after delivery. Outcomes were defined as nonpersistence (clearance of the HPV in the 2nd sample), re-infection (detection of different types of HPV in the 2 samples), and type-specific HPV persistence (the same HPV type found in both samples). An unfavourable cytological outcome was considered when the second exam showed progression to squamous intraepithelial lesion or high squamous intraepithelial lesion. Ninety patients were studied. HPV DNA persistence occurred in 50% of the cases composed of type-specific persistence (30%) or re-infection (20%). A low CD4+T-cell count at entry was a risk factor for type-specific, re-infection, or HPV DNA persistence. The odds ratio (OR) was almost three times higher in the type-specific group when compared with the re-infection group (OR = 2.8; 95% confidence interval: 0.43-22.79). Our findings show that bonafide (type-specific) HPV persistence is a stronger predictor for the development of cytological abnormalities, highlighting the need for HPV typing as opposed to HPV DNA testing in the clinical setting.
authors.affiliation: Instituto de Ginecologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Angela Ri
authors.initials: AR
authors.lastname: Meyrelles
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
authors.forename: Juliana D
authors.initials: JD
authors.lastname: Siqueira
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Pâmela P Dos
authors.initials: PP
authors.lastname: Santos
authors.affiliation: Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Cristina B
authors.initials: CB
authors.lastname: Hofer
authors.affiliation: Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Ronir R
authors.initials: RR
authors.lastname: Luiz
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
authors.forename: Héctor N
authors.initials: HN
authors.lastname: Seuánez
authors.affiliation: Instituto de Ginecologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Gutemberg
authors.initials: G
authors.lastname: Almeida
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Soares
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
authors.forename: Esmeralda A
authors.initials: EA
authors.lastname: Soares
authors.affiliation: Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Machado
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D060085:Coinfection; D003588:Cytopathogenic Effect, Viral; D004279:DNA, Viral / Q000145:classification* / Q000302:isolation & purification; D005260:Female; D006678:HIV / Q000145:classification* / Q000302:isolation & purification; D006679:HIV Seropositivity / Q000821:virology*; D006801:Humans; D008137:Longitudinal Studies; D058889:Molecular Typing / Q000379:methods; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010802:Phylogeny; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011446:Prospective Studies; D012008:Recurrence; D060737:Reproductive Tract Infections / Q000821:virology; D012307:Risk Factors; D012959:Socioeconomic Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D004279:DNA, Viral