L. Ahdieh et al., Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women, AM J EPIDEM, 151(12), 2000, pp. 1148-1157
Citations number
34
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
Increased risk for cervical intraepithelial neoplasia (CIN) in human immuno
deficiency virus (HIV)-infected women may be explained by repeated positivi
ty of human papillomavirus (HPV) infection facilitated by HIV infection and
related immunosuppression. As part of a longitudinal study with semiannual
examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), pr
ovided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polyme
rase chain reaction-based assay between 1992 and 1998. HPV positivity and t
ime to HPV clearance according to HIV serostatus and CD4(+) cell count were
compared using models for correlated binary data and survival analysis. Of
the 187 participants who had at least one positive measurement, the probab
ility of subsequent HPV positivity among HIV- women and HIV+ women with CD4
(+) greater than or equal to 200 and <200 cells/mu l was 47.5%, 78.7%, and
92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustere
d) in each group (p < 0.01). Compared with HIV- participants, the relative
incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4(+) 2
200 and <200 cells/mu l (p < 0.001). At the end of follow-up, 11 women had
biopsy-confirmed GIN. The association of HIV and CIN (p = 0.014) was fully
explained by repeated HPV positivity induced by HIV infection (p = 0.648).
Reversal of immunosuppression following potent antiretroviral therapy must
be expected to have a dramatic impact on HIV-related GIN.