Prevalence of risk factors associated with human papillomavirus infection in women living with HIV

Background: Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examine d risk factors for HPV infection at study entry in HIV-positive women enrol led in the Canadian Women's HIV Study, a prospective open cohort study. Methods: Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women's HIV Study for whom HPV test results were avai lable. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detect ion and typing by polymerase chain reaction were obtained at study entry. Results: Overall, 67.2% (252/375) of the women were HPV-positive; the globa l prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% ( 184/375). Women with squamous cell dysplasia (32/294) were more likely to h ave HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of l ifetime partners and history of STD, revealed that the following risk facto rs were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (CI ) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% CI 1.17-3. 42 (p = 0.011)]), inconsistent condom use in the 6 months before study entr y (adjusted OR 2.02 [95% CI 1.16-3.50 (p = 0.013)]), and lower age, with wo men age 30-39 years (adjusted OR 0.51 [95% Ci 0.30-0.87 (p = 0.013)]) and a ge 40 years or older (adjusted OR 0.52 [95% CI 0.26-1.01 (p = 0.052)]) comp ared with women less than 30 years of age. Interpretation: Close monitoring for HPV-related effects is warranted in al l HIV-positive women, particularly younger, non-white women who do not alwa ys use condoms. Counselling for women living with HIV, particularly younger women, should emphasize the importance of regular cytological screening, w ith increasing frequency as the CD4 count falls.