title: Prevalence of human papillomavirus infection & cervical abnormalities in HIV-positive women in eastern India.
abstract: OBJECTIVE
  India has the third highest burden of HIV and highest number of cervical cancer in the world. A cross-sectional study was performed to determine the prevalence and types of human papillomavirus (HPV) infection, and the factors associated with HPV infection and abnormal cervical cytology in HIV-positive women attending the Antiretroviral Therapy (ART) Centre in a tertiary care hospital in eastern India.
  
  
  METHODS
  We screened 216 HIV- positive women with Papanicolau smear cytology and HPV testing. HPV DNA was detected by using consensus primers followed by sequencing.
  
  
  RESULTS
  Of the 216 HIV-positive women screened, 58 (26.85%) were HPV-positive; 56 (25.9%) were of high-risk (HR) HPV type. The most prevalent HPV type was HPV-16 (7.9%); non 16 and 18 HPV types were present in 17.6 per cent patients. Age ≤ 35 yr [(OR), 2.56 (1.26-5.19)], illiteracy [OR, 2.30 (1.19-4.46)], rural residence [OR, 3.99 (1.27-12.56)] and CD4 ≤ 350/µl [OR, 2.46 (1.26-4.83)] were associated with increased risk of acquisition of HPV. One hundred thirty nine (74.33%) patients had normal/ negative for intraepithelial lesions (NILM) cytology, three (1.60%) had atypical squamous cells of undetermined significance (ASCUS), 32 (17.11%) had low-grade squamous intraepithelial lesions (LSIL), 10 (5.35%) had high-grade squamous intraepithelial lesions (HSIL) and three (1.60%) had carcinoma cervix. WHO clinical Stage III and IV [OR, 2.83 (1.07-7.49)] and CD4 ≤ 350/µl [OR, 2.84 (1.30-6.20)] were risk factors for abnormal cytology.
  
  
  CONCLUSIONS
  Our study showed 26.85 per cent HPV positivity in HIV infected women in this region, with HPV-16 as the commonest genotype. Abnormal cervical cytology was seen in about 25 per cent women. Regular Pap smear screening as recommended by the National AIDS Control Organization will help in early detection of cervical abnormalities in HIV- positive women.
authors.affiliation: Department of Medicine & Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Jaya
authors.initials: J
authors.lastname: Chakravarty
authors.forename: Ankita
authors.initials: A
authors.lastname: Chourasia
authors.forename: Minaxi
authors.initials: M
authors.lastname: Thakur
authors.forename: Abhishek Kumar
authors.initials: AK
authors.lastname: Singh
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Nisha Rani
authors.initials: NR
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D000368:Aged; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D003581:Cytodiagnosis; D005260:Female; D005838:Genotype; D006678:HIV / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007194:India; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology