Cervicovaginal human papillomavirus infection in human immunodeficiency virus-1 (HIV)-positive and high-risk HIV-negative women

Background: Human papillomavirus (HPV) infection is associated with precanc erous cervical squamous intraepithelial lesions commonly seen among women i nfected with human immunodeficiency virus-1 (HIV), We characterized HPV inf ection in a large cohort of HIV-positive and HIV-negative women participati ng in the Women's Interagency HIV Study to determine the prevalence of and risk factors for cervicovaginal HPV infection in HIV-positive women, Method s: HIV-positive (n = 1778) and HIV-negative (n = 500) women were tested at enrollment for the presence of HPV DNA in a cervicovaginal lavage specimen. Blood samples were tested for HIV antibody status, level of CD4-positive T cells, and HIV RNA load (copies/mL), An interview detailing risk factors w as conducted. Univariate and multivariate analyses were performed. Results: Compared with HIV-negative women, HIV-positive women with a CD4(+) cell co unt of less than 200/mm(3) were at the highest risk of HPV infection, regar dless of HIV RNA load (odds ratio [OR] = 10.13; 95% confidence interval [CI ] = 7.32-14.04), followed by women with a CD4+ count greater than 200/mm3 a nd an HIV RNA load greater than 20 000 copies/mL (OR = 5.78; 95% CI = 4.17- 8.08) and women with a CD4(+) count greater than 200/mm3 and an HIV RNA loa d less than 20 000 copies/mL (OR = 3.12; 95% CI = 2.36-4.12), after adjustm ent for other factors. Other risk factors among HIV-positive women included racial/ethnic background (African-American versus Caucasian, OR = 1.64; 95 % CI = 1.19-2.28), current smoking (yes versus no; OR = 1.55; 95% CI = 1.20 -1.99), and younger age (age <30 years versus greater than or equal to 40 y ears; OR = 1.75; 95% CI = 1.23-2.49). Conclusions: Although the strongest r isk factors of HPV infection among HIV-positive women were indicators of mo re advanced HIV-related disease, other factors commonly found in studies of HIV-negative women, including racial/ethnic background, current smoking, a nd age, were important in HIV-positive women as well.