Abstract
Infection, coinfection and type-specific human papillomavirus (HPV) distribution was evaluated in human immunodeficiency virus (HIV)-positive women from paired cervical and urine samples. Paired cervical and urine samples (n = 204) were taken from HIV-positive women for identifying HPV-DNA presence by using polymerase chain reaction (PCR) with three generic primer sets (GP5+/6+, MY09/11 and pU1M/2R). HPV-positive samples were typed for six high-risk HPV (HR-HPV) (HPV-16, -18, -31, -33, -45 and -58) and two low-risk (LR-HPV) (HPV-6/11) types. Agreement between paired sample results and diagnostic performance was evaluated. HPV infection prevalence was 70.6% in cervical and 63.2% in urine samples. HPV-16 was the most prevalent HPV type in both types of sample (66.7% in cervical samples and 62.0% in urine) followed by HPV-31(47.2%) in cervical samples and HPV-58 (35.7%) in urine samples. There was 55.4% coinfection (infection by more than one type of HPV) in cervical samples and 40.2% in urine samples. Abnormal Papanicolau smears were observed in 25.3% of the women, presenting significant association with HPV-DNA being identified in urine samples. There was poor agreement of cervical and urine sample results in generic and type-specific detection of HPV. Urine samples provided the best diagnosis when taking cytological findings as reference. In conclusion including urine samples could be a good strategy for ensuring adherence to screening programs aimed at reducing the impact of cervical cancer, since this sample is easy to obtain and showed good diagnostic performance.
Highlights
The human immunodeficiency virus (HIV) is a sexuallytransmitted infection (STD) having a great impact around the world due to the large amount of people living with such infection (34.2 million) and the frequent appearance of new cases (2.5 million in 2011) [1]
Some studies have suggested that women living with HIV/ AIDS have increased frequency and incidence of single and multiple infections caused by human papillomavirus (HPV) [3]; the natural history of infection becomes altered, thereby leading to an increased risk of developing cervical cancer (CC) and contributing towards this type of cancer being the most frequently diagnosed in HIV-positive women [4]
Type-specific viral identification revealed that HPV-16 had the greatest prevalence in both samples, whilst HPV-31 had the second greatest prevalence in the cervical samples and HPV-58 in urine samples; the other viral types had a variable distribution in both samples (Figure 1)
Summary
The human immunodeficiency virus (HIV) is a sexuallytransmitted infection (STD) having a great impact around the world due to the large amount of people living with such infection (34.2 million) and the frequent appearance of new cases (2.5 million in 2011) [1]. Some studies have suggested that women living with HIV/ AIDS have increased frequency and incidence of single and multiple infections caused by human papillomavirus (HPV) [3]; the natural history of infection becomes altered, thereby leading to an increased risk of developing cervical cancer (CC) and contributing towards this type of cancer being the most frequently diagnosed in HIV-positive women [4] This relationship may be due to: higher HPV exposure in HIV-infected women, increased frequency of main risk factors involved in CC development or the role of HIV-related immunosuppression in favoring carcinogenesis [5]. These clinical features are altered in women infected simultaneously with HPV and HIV where a short-term clinical outcome usually occurs, involving lesions developing more aggressively, slower HPV infection regression rates and poorer responses to treatment [9]; such factors mean that pre-cancerous lesions could reach 60% (evolving in less than 3 years) [10]
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