Abstract
BackgroundIn Brazil, the rate of cervical cancer remains high despite the availability of screening programs. With ongoing vaccine development and implementation, information on the prevalence of specific HPV types is needed, particularly among high-risk populations, such as HIV-infected women.MethodsWe performed a study of HIV-infected women in Rio de Janeiro, Brazil, who underwent cervical HPV genotype testing between 2005-2013. We examined the prevalence of high-risk HPV types and the patterns of high-risk HPV type clustering. Using logarithmic binomial regression, we estimated the risk of abnormal cytology by HPV genotype result.ResultsOf the 562 women included, 498 (89 %) had at least one HPV type detected. 364 women (65 %) had at least one high-risk HPV type detected and 181 (32 %) had more than one high-risk type detected. HPV 58 was the most frequent HPV type detected overall (prevalence 19.8 % [95 % confidence interval 16.4–23.1]), followed by HPV 53 (prevalence 15.5 % [12.5–18.5]) and HPV 16 (prevalence 13 % [10.2–15.8]). Women infected with more than one high-risk HPV type were younger, had lower CD4+ lymphocyte counts, and were more likely to be infected with HPV 16 or 18. In adjusted analyses, presence of more than one high-risk HPV type was associated with a two-fold increased risk of abnormal cytology after adjusting for presence of individual high-risk type, age, and CD4+ lymphocyte count (adjusted prevalence ratios 1.88–2.07, all p <0.001). No single high-risk HPV type was statistically associated with abnormal cytology after adjusting for the presence of more than one high-risk HPV type.ConclusionsIn the largest study of cervical HPV genotypes among HIV-infected women in Latin America, infection by high-risk HPV types other than 16 or 18 and infection by more than one high-risk HPV types were common. Infection by more than one high-risk type was more strongly associated with abnormal cervical cytology than any individual high-risk HPV type, highlighting the need for multi-valent HPV vaccines.
Highlights
In Brazilian National STD/AIDS Program (Brazil), the rate of cervical cancer remains high despite the availability of screening programs
Among HIV-infected women in Latin America, prevalence of cervical human papillomavirus (HPV) infection in women with normal cervical cytology has been estimated at 57 %, similar to the prevalence observed in HIV-infected women in Africa (57 %) and higher than that observed in HIV-infected women in Asia (31 %), Europe (32 %), or North America (31 %) [13]
We examined the prevalence of each high-risk HPV type and of more than one high-risk type by cervical cytology outcome, defined as the proportion of women with the cytological outcome who were positive for the high-risk HPV type
Summary
In Brazil, the rate of cervical cancer remains high despite the availability of screening programs. In Latin America, high-risk human papillomavirus (HPV) type 16 has been strongly associated with risk of high-grade cervical dysplasia and cervical. Women with HIV infection have higher prevalence of high-risk HPV types, are more likely to be infected with more than one HPV type, and are at increased risk of cervical dysplasia and cervical cancer [5,6,7,8,9,10,11]. HIV-infected women are more likely to have abnormal cervical cytology and dysplasia associated with high-risk HPV types other than 16. A recent large study of pregnant HIV-infected women in Rio de Janeiro, Brazil, noted an overall cervical HPV prevalence of 84 %, 80 % of whom were infected by high-risk types [15]. While some studies have shown a protective effect, combination antiretroviral therapy (cART) has not consistently been observed to affect rates of cervical intraepithelial neoplasia and only modestly improves HPV infection clearance [7, 16,17,18,19,20,21]
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