CERVICOVAGINAL HUMAN PAPILLOMAVIRUS INFECTION IN HIV-POSITIVE AND HIGH RISK HIV-NEGATIVE WOMEN

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Background: Human papillomavirus (HPV) infection is strongly associated with cervical squamous intracpithelial lesions (CSIL) and cervical cancer. The prevalence of CSIL has been shown to be increased among HIV-−positive women, and has a more aggressive course. Relatively little is known about the prevalence of HPV infection, the range of HPV types present, and risk factors for HPV infection in these women. This study was designed to characterize HPV infection in the Women's Interagency HIV Study(WHIS), a large prospective cohort study of HIV+ women and high-risk HIV-− women from 6 sites around the U.S. Methods: 1781 HIV+ and 501 HIV− women participating in the WHIS study were included in this baseline analysis. Each underwent an extensive interview, physical examination and gynecologic examination, and the HIV− women were matched to the HIV+ women for age, drug use and number of sexual partners. HPV was sought in a cervicovaginal lavage specimen using the polymerase chain reaction with the HPV L1 consensus primers and probes in a dot-blot format, followed by specific typing for 39 different HPV types. Results: 1033 of 1781 (58%) of HIV+ and 134 of 501 (27%) of HIV- women were positive for one or more HPV types (p<0.001). Similarly, the number of HPV types detected was higher among HIV+ women (42% of HIV+ women had 2 or more types compared to 16% of HIV− women, p<0.0010 and infection with multiple HPV types was most common among women with CD4 counts less than 200/mm3 (51%). In multivariate analysis of risk factors for HPV infection. HIV positivity with lower CD4 counts (OR 9.7 for HIV+, CD4<200/mm3 vs. HIV−), race/ethnic group (OR African-American 1.9, OR Hispanic 1.6 vs. Caucasian), younger age (OR 2.1 age <30 years vs.>40 years) and current smoking (OR 1.5) were significantly associated with HPV infection at baseline (p for each factor <0.001). HPV types were widely distributed in both HIV+ and HIV− women with no single predominant type found in either group. Number of male sexual partners in the last 6 months or five years was not significantly associated with either HPV infection in multivariate analysis nor with infection with multiple HPV types. Conclusions: HIV+ women were at higher risk of HPV infection with multiple HPV types, with increasing prevalence of multiple infection with decreasing CD4 level. There was little difference in the spectrum of HPV types between HIV+ and HIV− women. The role of infection with multiple HPV types in the pathogenesis of CSIL and cancer is unknown. In this sexually active population, our data are consistent with the possibility that infection with single or multiple HPV types reflects an immune-mediated increase in replication of low-level HPV infection rather than recent acquisition of new HPV types through sexual activity. Supported by grant number U01 AI-DE34989.