Prevalence of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls - Impact of infection with human immunodeficiency virus

Context: Data suggest that in adults, human papillomavirus (HPV) infections and their sequalae, squamous intraepithelial lesions (SILs), occur more co mmonly among human immunodeficiency (HIV)-infected women because of the HIV -associated CD4(+) T-cell immunosuppression. Since adolescents are more lik ely to be early in the course of HIV and HPV infections, the study of both infections in this age group may help elucidate their initial relationship. Objective: To examine the prevalence of and risks for cervical HPV infectio n and SILs by HIV status in a population of adolescent girls. Participants: Subjects recruited at each of the 16 different US sites parti cipating in a national study of HIV infection in adolescents. Main Outcome Measures: Cervical HPV DNA findings using polymerase chain rea ction detection techniques and Papanicolaou smear from baseline visits. Inf ection with HPV was categorized into low- (rarely associated with cancer) a nd high- (commonly associated with cancers) risk types. Results: Of 133 HIV-infected girls, 103 (77.4%) compared with 30 (54.5%) of 55 noninfected girls were positive for HPV (relative risk [RR], 1.4; 95% c onfidence interval [CI], 1.1-1.8). The risk was for high-risk (RR, 1.8; 95% CI, 1.2-2.7) but not low-risk (RR, 1.2; 95% CI, 0.4-3.9) HPV types. Among the girls with HPV infection, 21 (70.0%) of the non-HIV-infected girls had normal cytologic findings compared with only 29 (29.9%) of the HIV-infected girls (P<.001). Multivariate analysis showed that HIV status was a signifi cant risk for HPV infection (odds ratio [OR], 3.3; 95% CI, 1.6-6.7) and SIL (OR, 4.7; 95% CI, 1.8-14.8), but CD4 cell count and viral load were not as sociated with infection or squamous intraepithelial lesions. Only 9 girls h ad a CD4(+) T-cell count of less than 0.2 cell X 10(9)/L. Conclusions: High prevalence of HPV infection in both groups underscores th e risky sexual behavior in this adolescent cohort. Rates of HPV infection a nd SILs were higher among HIV-infected girls, despite similar sexual risk b ehaviors and the relatively healthy state of our HIV-infected group. Infect ion with HIV may enhance HPV proliferation through mechanisms other than CD 4 immunosuppression, particularly early in the course of HIV infection.