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Abstract
Persistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher rate of persistent infections and an earlier progression to cancer. We aimed to evaluate HR-HPV prevalence, incidence and clearance, and its association with HIV viral suppression, immunological response and other risk factors among WLHA followed at an STD/HIV reference center. This was a cohort study conducted at a reference center for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months after enrolment, where socio-epidemiological data were obtained. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS® Roche) in addition to blood samples for CD4+ T lymphocyte count and HIV viral load. We prospectively evaluated 333 women. HR-HPV DNA prevalence was 33.3% at baseline. HPV-16 was present in 5.1%, HPV-18 in 3.9% and 29.4% WLHA had other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). The HR-HPV incidence during the follow-up was 10.8%, at the 6-month visit was 7.7% and at the 12-month visit was 3.7%. Variables associated with HR-HPV incidence were: nulliparity, combined oral contraceptive use and detectable HIV viral load. The HR-HPV clearance rate was 41.7% and was associated with age >30 years and lymphocyte T CD4 count >500 cells/mm3 at enrolment. These findings contribute to the knowledge about a group of women that need more careful HPV screening and describe the association between an efficient immunological response and HIV viral suppression with lower incidence and increased clearance of HR-HPV.
Highlights
Cervical cancer was considered an AIDS-defining disease by the CDC in 1993 [1]
Three hundred and thirty-eight women were included at the beginning of this study, and five were excluded from the analysis: three women asked to withdraw consent, stating that they had no spare time for the subsequent follow-up visits, one woman whose first sample was not processed, and one woman who died before the first follow-up visit (S1 Fig)
258 WLHA returned for the 6-month follow-up appointment (77.5% of the initial population), and 280 WLHA returned for the 12-month follow-up appointment (84.1% of the initial population)
Summary
Cervical cancer was considered an AIDS-defining disease by the CDC in 1993 [1]. HPV infection occurs more frequently in women living with HIV/AIDS (WLHA), and with a higher number of multiple high-risk viral types compared to the general population [2]. HPV incidence and clearance in Brazilian HIV-infected women deficiency is another risk factor and, while allowing higher persistence of HPV, it induces the development of lesions at sites other than the cervix, such as the vagina, vulva and anus, which are more frequent and difficult to treat [3]. The progression from a high-grade lesion to cancer is faster in WLHA than in the general population. The mechanisms involved in the rate of progression in these women is unclear, the continuous reduction in cellular immunity and the presence of chronic inflammation play a decisive role in this process [4]
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