A longitudinal study of HPV detection and cervical pathology in HIV infected women

Objective: To monitor the presence and persistence of high risk (HR) human papillomavirus (HPV) in cervical brushings from HIV infected women. Methods: Prospective observational cohort study of HN infected women. Women were enrolled from the cohort of 164 HIV infected women who attend the col poscopy clinic at the Edinburgh Regional Infectious Diseases Unit. A single cervical brush scrape was obtained from 39 women and two or more samples f rom 63 women who attended regularly at approximately 6 monthly intervals. H PV typing was carried out using a commercial hybrid capture assay (HCA). De tails of antiretroviral therapy, cytological assessment, and histological e valuation were made available and the interrelation with HR-HPV detection a nalysed. Results: Abnormal cervical cytology, particularly of low grade, was common in these HN infected women. HR-HPV types were detected in 25% of the women with normal cytology, while over 80% of those with abnormal cytology of any grade were HR-HPV positive. Persistent HR-HPV, as defined by two or more c onsecutive HPV positive results, was common and found in 27/63 women from w hom multiple samples were obtained. HR-HPV was detected at high levels whet her or not patients were receiving antiretroviral therapy. Profound immunos uppression was not necessarily associated with progression of cervical dise ase and no cases of invasive cervical disease were seen. Conclusion: While mild dyskaryosis (low grade squamous intraepithelial lesi on (LSIL)) and persistence of HR-HPV are common in HIV infected women in Ed inburgh, regular cytological and colposcopic evaluation with appropriate in tervention and treatment appears to limit the progression of cervical disea se.