Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark - the SHADE.
Women living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH.



WLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities. WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities.



Of 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)).



WLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART.
Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. Kristina.thorsteinsson@gmail.com.|Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark. Kristina.thorsteinsson@gmail.com.
Kristina
0000-0002-4855-7049
K
Thorsteinsson
Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
Merete
M
Storgaard
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Terese L
TL
Katzenstein
Clinical Research Center, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
Steen
S
Ladelund
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Frederikke Falkencrone
FF
Rønsholt
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Isik Somuncu
IS
Johansen
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Gitte
G
Pedersen
Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark.
Lailoma
L
Hashemi
Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
Lars Nørregård
LN
Nielsen
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.|Department of Obstetrics and Gynaecology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
Lisbeth
L
Nilas
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Niels
N
Obel
Molecular Pathology Laboratory, Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
Jesper
J
Bonde
Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Anne-Mette
AM
Lebech
D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology*; D060085:Coinfection; D003718:Denmark; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D011159:Population Surveillance; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000209:etiology / Q000473:pathology
Cervical cytological abnormalities; HPV vaccine; High-risk human papillomavirus; Highly active antiretroviral therapy; Women living with HIV