Abstract
BackgroundYunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China. We conducted an observational study to evaluate the human papillomavirus (HPV) genotype distribution in relation to cervical neoplastic disease risk among HIV-infected women in Yunnan.MethodsWe screened 301 HIV-infected non-pregnant women in Mangshi prefecture in Yunnan province. All consenting participants underwent simultaneous and independent assessment by cervical cytology, colposcopy-histopathology, and HPV genotyping. Unadjusted and multivariable-adjusted multinomial logistic regression analysis was conducted to evaluate factors associated with single or multiple carcinogenic HPV genotypes.ResultsHPV genotypes were present in 43.5% (131/301) overall, and carcinogenic HPV genotypes were present in 37.5% (113/301) women. Among women with carcinogenic HPV genotypes, 80 (70.8% of 113) had a single carcinogenic HPV type, while 33 (29.2%) women had multiple (2 or more) carcinogenic HPV types. Overall, the most common carcinogenic HPV types were HPV52 (7.3%), HPV58 (6.6%), HPV18 (6.3%), HPV16 (6.0%), and HPV33 (5.3%). In women with cervical precancerous lesions (i.e., high-grade squamous intraepithelial lesions [HSIL] on cytology or cervical intraepithelial neoplasia grade 2 or worse [CIN2+] detected on colposcopy-histology), the most commonly detected genotypes were HPV16 (28.6%), HPV52 (25.0%), HPV58 (17.9%), HPV18 (10.7%) and HPV31 (10.7%). Increasing age was an independent risk factor associated with presence of single carcinogenic HPV types (adjusted odds ratio: 1.04, 95%CI: 1.01-1.07, p = 0.012) but not with the presence of multiple carcinogenic types in the multivariable-adjusted models.ConclusionsAs HIV-infected women continue to live longer on antiretroviral therapy in China, it will be increasingly important to screen for, and prevent, HPV-associated cervical cancer in this population, especially given the wide diversity and multiplicity of HPV genotypes.
Highlights
Yunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China
The advent of antiretroviral therapy (ART) for treatment of HIV/acquired immunodeficiency syndrome (AIDS) has significantly increased the life-spans of HIV-infected women, yet has increased their risk for a prolonged period of persistence of human papillomavirus (HPV) infection, and increased risk of progression to cervical precancer and cancer [4]
HIV-infected women are 4–5 times more likely to have Invasive cervical cancer (ICC) compared to HIV-uninfected women and ICC has been classified as an AIDS-defining malignancy [5]
Summary
Yunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China. We conducted an observational study to evaluate the human papillomavirus (HPV) genotype distribution in relation to cervical neoplastic disease risk among HIV-infected women in Yunnan. Women with immunosuppressive conditions, such as human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), have been shown to have a higher prevalence of cervical HPV infection and higher frequency of multiple HPV genotypes than women from the general population [3]. The overall national HIV prevalence estimates remains low (0.058%), but the epidemic is concentrated in some geographical regions such as Yunnan, a province in Southwestern China with a high HIV burden, accounting for 34.8% of the estimated number of cases nationally [7]. Limited data is available on the burden and genotypes of HPV among HIV-infected women in this or other settings in China [8,9,10]. To expand the evidence in this area, we undertook a descriptive epidemiology study to evaluate the presence and distribution of HPV genotypes and correlated these with cervical disease status in this population
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