Human Papillomavirus Infections in Human Immunodeficiency VirusInfected Women: A Risk Factor Analysis Open Access

Cain, Joan (2009)

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Objective. The aim of this study was to determine the high risk human papillomavirus (HR- HPV) prevalence and specific risk factors for abnormal Papanicolaou (Pap) smear in a human immunodeficiency virus (HIV) infected population. Additionally, the utility of HPV viral load using relative light unit (RLU) readings in predicting cervical disease was assessed. Methods. This is a cross-sectional study with 569 HIV-infected women who were enrolled from six different cities across the United States. Risk factor analysis was performed using multivariate logistic regression. Findings. A total of 486 HIV-infected women were included in this analysis. HR-HPV was found in 45% of the population with 25% having an infection with type 16 or 18. For the group as a whole, history of an abnormal Pap smear, CD4 count <200, history of antiretroviral use, presence of HR-HPV regardless of RLU cut-off, and presence of low risk HPV (LR-HPV) were found to be risk factors for an abnormal Pap smear. On subgroup analysis of those co-infected with HR-HPV and HIV, history of antiretroviral use, RLU ≥ 20, CD4 count < 200, history of an abnormal Pap smear, and infection with more than one HR-HPV type were found to be risk factors for an abnormal Pap smear. Finally, a strong association between having an abnormal Pap smear and presence of HR-HPV with an RLU ≥ 20 (RR=55.2) was found. Conclusions: This study was able to identify important predictors of having an abnormal Pap smear in HIV-infected women which may help to individualize follow-up and treatment. HPV viral load as measured by RLU was found to be predictive of cervical disease which could prove useful in resource poor areas where further testing is not readily available. Finally, only 25% of those infected with HR-HPV were infected with either 16 or 18. This implies that in HIV- infected women the vaccine subtypes may need to be broadened.

Table of Contents

Table of Contents I. Introduction II. Background III. Methods IV. Results V. Discussion VI. References VII. Tables

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