HUMAN-PAPILLOMAVIRUS INFECTION IN WOMEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Background Among women infected with the human immunodeficiency virus (HIV), there is a high prevalence of human papillomavirus (HPV) infect ions. However, little is known about the natural history of HPV infect ions in HIV-seropositive women, and persistent HPV infections may expl ain the increased risk of cervical squamous intraepithelial lesions an d invasive cervical cancer in HIV-seropositive women. Methods A total of 220 HIV-seropositive and 231 HIV-seronegative women in the New York City area were evaluated at two or more semiannual gynecologic examin ations that included a Pap test, a test for HPV DNA, and colposcopy. R esults HPV DNA was detected at the initial ex amination in 56 percent of the HIV-seropositive and 31 percent of the HIV-seronegative women. After four examinations, the cumulative prevalence of HPV infection wa s 83 percent in the seropositive women and 62 percent in the seronegat ive women (P<0.001). Persistent HPV infections were found in 24 percen t of the seropositive women but in only 4 percent of the seronegative women (P<0.001). Twenty percent of the seropositive women and 3 percen t of the seronegative women had persistent infections with HPV-16-asso ciated viral types (16, 31, 33, 35, or 58) or HPV-18-associated types (18 or 45) (P<0.001), which are most strongly associated with cervical cancer. The detection of HPV DNA in women with previously negative te sts was not associated with sexual activity during the interval since the preceding examination. Conclusions HIV-seropositive women have a h igh rate of persistent HPV infections with the types of HPV that are s trongly associated with the development of high-grade squamous intraep ithelial lesions and invasive cervical cancer. These persistent infect ions may explain the increased incidence of squamous intraepithelial l esions in HIV-seropositive women. (C) 1997, Massachusetts Medical Soci ety.