Increased risk of cervical disease among human immunodeficiency virus-infected women with severe immunosuppression and high human papillomavirus load

Objective: To investigate human papillomavirus (HPV) genotypes, HPV DNA loa d, and behavioral and sociodemographic factors in a series of human immunod eficiency virus (HIV)-seropositive women, and to correlate HPV infection wi th cervical disease according to immune status. Methods: Three hundred seven HIV-seropositive women were tested for the pre sence of HPV DNA by polymerase chain reaction (PCR) and Southern blot hybri dization. Cervical disease was assessed using Papanicolaou smears, colposco py, and biopsies when necessary. Various risk factors for cervical intraepi thelial neoplasia (CIN) were tested using multiple logistic regression anal ysis. Results: Cervical disease was diagnosed in 83 (27.0%) of 307 women and HPV infection in 162 (52.8%). High HPV load (as detectable by Southern blot hyb ridization) was found in 90 (55.6%) of the 162 infected women. Potentially oncogenic or related genotypes were detected in 74 (82.2%) of these 90 case s. High-load HPV infection was twice as frequent in severely immunosuppress ed women (CD4 cell count less than 200/mu L) as in women with higher CD4 ce ll counts (P = .002). High-load HPV infection was associated with a high ri sk of cervical disease (adjusted odds ratio [OR] 16.8; 95% confidence inter val [CI] 7.0, 40.3). The risk among severely immunosuppressed women was ten times greater than that among women with CD4 cell counts of at least 200/m u L. Low-load HPV infection (detected by PCR only) was a risk factor for CI N in severely immunosuppressed women only (adjusted OR 7.4; 95% CI 1.3, 43. 0). Conclusion: Immunosuppression favors cervical high-load HPV infection with oncogenic genotypes and its clinical expression in HIV-seropositive women. (Obstet Gynecol 2000;96:403-9. (C) 2000 by The American College of Obstetri cians and Gynecologists.).