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Hidjo M, Mukhedkar D, Masimirembwa C, Lei J, Arroyo Mühr LS. Cervical cancer microbiome analysis: comparing HPV 16 and 18 with other HPV types. Sci Rep 2024; 14:22014. [PMID: 39317706 PMCID: PMC11422507 DOI: 10.1038/s41598-024-73317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024] Open
Abstract
Differences in the cervicovaginal microbiome may influence the persistence of HPV and therefore, the progression to cervical cancer. We aimed to analyze and compare the metatranscriptome of cervical cancers positive for HPV 16 and 18 with those positive for other HPV types to understand the microbiome's influence on oncogenicity. RNA sequencing data from a total of 222 invasive cervical cancer cases (HPV16/18 positive (n=42) and HPV "Other types" (n=180)) were subjected to taxonomy classification (Kraken 2) including bacteria, virus and fungi to the level of species. With a median depth of 288,080.5 reads per sample, up to 107 species (38 bacterial, 16 viral and 53 fungal) were identified. Diversity analyses revealed no significant differences in viral or fungal species between HPV16/18 and other HPV types. Bacterial alpha diversity was significantly higher in the "Other HPV types" group for the Observed index (p=0.0074) (but not for Shannon). Cumulative species curves revealed greater species diversity in the "Other HPV types" group compared to "HPV16/18 but no significant differences in species abundance were found between HPV groups. The study did not detect strong significant microbiome differences between HPV 16/18 and other HPV types in cervical cancers. Further research is necessary to explore potential factors influencing the oncogenicity of different HPV types and their interaction with the cervical microbiome.
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Affiliation(s)
- Maire Hidjo
- Department of Genomic Medicine, African Institute of Biomedical Science and Technology, 911 Boronia Township, Beatrice, Harare, Zimbabwe
- University of Witwatersrand Sydney Brenner Institute for Molecular Biosciences, Johannesburg, 2193, South Africa
| | - Dhananjay Mukhedkar
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 86, Stockholm, Sweden
- Hopsworks AB, Åsögatan 119, Plan 2, 116 24, Stockholm, Sweden
| | - Collen Masimirembwa
- Department of Genomic Medicine, African Institute of Biomedical Science and Technology, 911 Boronia Township, Beatrice, Harare, Zimbabwe
- University of Witwatersrand Sydney Brenner Institute for Molecular Biosciences, Johannesburg, 2193, South Africa
| | - Jiayao Lei
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 86, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Solna, Sweden
| | - Laila Sara Arroyo Mühr
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 86, Stockholm, Sweden.
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Krankowska D, Mazzitelli M, Ucak HA, Orviz E, Karakoc HN, Mortimer H, Aebi-Popp K, Gilleece Y. Screening and prevention of HPV-related anogenital cancers in women living with HIV in Europe: Results from a systematic review. HIV Med 2024; 25:769-793. [PMID: 38238990 DOI: 10.1111/hiv.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Women living with HIV (WLWH) are at increased risk of human papillomavirus (HPV)-related cancers. Throughout Europe, there is great heterogeneity among guidelines for screening programmes, access to HPV testing and HPV vaccination. The aim of this systematic review is to summarize available data on screening and prevention measures for HPV-related anogenital cancers in WLWH across the WHO European Region (WER). METHODS The systematic review followed the PRISMA guidelines and was registered on Prospero. PubMed, Embase and Web of Science databases were searched to identify available studies, written in English and published between 2011 and 2022. A metanalysis was conducted using random-effects models to calculate pooled prevalence of HPV. Subgroup analyses were conducted according to country and HPV testing. RESULTS Thirty-four articles involving 10 336 WLWH met the inclusion criteria. Studies were heterogenous in their methodology and presentation of results: 73.5% of studies focused on cervical cancer prevention, and only 4.4% on anal cancer; 76.5% of studies conducted HPV testing as a routine part of screening. The prevalence of high-risk HPV was 30.5-33.9% depending on the detection method used. A total of 77% of WLWH had cervical cytology results reported. Six studies reported the positive association of CD4 cell count <200 cells/μL with HPV prevalence and cervical abnormalities. Anal HPV testing was conducted in <8% of participants. HPV vaccination was completed in 5.6% of women (106/1902) with known vaccination status. There was no information about the vaccination status of the majority of women in the analysed studies (8434/10336). CONCLUSION Data about screening of HPV-related anogenital cancer in WLWH in Europe are heterogenous and lacking, especially in relation to anal cancer. HPV DNA testing is not routinely done as part of screening for HPV-related cancer; guidelines should include indications for when to use this test. Low CD4 count is a risk factor for HPV infection and cytological abnormalities. HPV vaccination data are poor and, when available, vaccination rates are very low among WLWH in Europe. This review concludes that significant improvements are required for data and also consistency on guidelines for HPV screening, prevention and vaccination in WLWH.
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Affiliation(s)
- Dagny Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warszawa, Poland
- Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | | | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clinico San Carlos, IdlSSC, Madrid, Spain
| | | | - Harriet Mortimer
- Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Obstetrics and Gynecology, Lindenhofspital, Bern, Switzerland
| | - Yvonne Gilleece
- Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
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Carlander C, Brännström J, Månsson F, Elvstam O, Albinsson P, Blom S, Mattsson L, Hovmöller S, Norrgren H, Mellgren Å, Svedhem V, Gisslén M, Sönnerborg A. Cohort profile: InfCareHIV, a prospective registry-based cohort study of people with diagnosed HIV in Sweden. BMJ Open 2023; 13:e069688. [PMID: 36931676 PMCID: PMC10030896 DOI: 10.1136/bmjopen-2022-069688] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
PURPOSE The Swedish InfCareHIV cohort was established in 2003 to ensure equal and effective care of people living with HIV (PLHIV) and enable long-term follow-up. InfCareHIV functions equally as a decision support system as a quality registry, ensuring up-to-date data reported in real time. PARTICIPANTS InfCareHIV includes data on >99% of all people with diagnosed HIV in Sweden and up to now 13 029 have been included in the cohort. InfCareHIV includes data on HIV-related biomarkers and antiretroviral therapies (ART) and also on demographics, patient-reported outcome measures and patient-reported experience measures. FINDINGS TO DATE Sweden was in 2015 the first country to reach the UNAIDS (United Nations Programme on HIV/AIDS)/WHO's 90-90-90 goals. Late diagnosis of HIV infection was identified as a key problem in the Swedish HIV-epidemic, and low-level HIV viraemia while on ART associated with all-cause mortality. Increased HIV RNA load in the cerebrospinal fluid (CSF) despite suppression of the plasma viral load was found in 5% of PLHIV, a phenomenon referred to as 'CSF viral escape'. Dolutegravir-based treatment in PLHIV with pre-existing nucleoside reverse transcriptase inhibitor-mutations was non-inferior to protease inhibitor-based regimens. An increase of transmitted drug resistance was observed in the InfCareHIV cohort. Lower efficacy for protease inhibitors was not due to lower adherence to treatment. Incidence of type 2 diabetes and insulin resistance was high in the ageing HIV population. Despite ART, the risk of infection-related cancer as well as lung cancer was increased in PLHIV compared with HIV-negative. PLHIV were less likely successfully treated for cervical precancer and more likely to have human papillomavirus types not included in current HPV vaccines. Self-reported sexual satisfaction in PLHIV is improving and is higher in women than men. FUTURE PLANS InfCareHIV provides a unique base to study and further improve long-term treatment outcomes, comorbidity management and health-related quality of life in people with HIV in Sweden.
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Affiliation(s)
- Christina Carlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Johanna Brännström
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Månsson
- Department of Clinical Sciences, Lund University, Infectious Diseases Research Unit, Malmo, Sweden
| | - Olof Elvstam
- Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Växjö Central Hospital, Växjö, Sweden
| | - Pernilla Albinsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Lena Mattsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sanne Hovmöller
- Department of Infectious Diseases, Sunderby Hospital, Lulea, Sweden
| | - Hans Norrgren
- Department of Clinical Sciences, Lund University Faculty of Science, Lund, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenbrug, Sweden
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Carlander C, Lagheden C, Eklund C, Nordqvist Kleppe S, Dzabic M, Wagner P, Sparén P, Dillner J. Nonvaccine human papillomavirus genotype common in women with HIV failing cervical precancer treatment. AIDS 2021; 35:2367-2374. [PMID: 34723851 DOI: 10.1097/qad.0000000000003026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess failure after treatment of high-grade cervical intraepithelial neoplasia (CIN2+) by HIV status and human papillomavirus (HPV) type. DESIGN A population-based register study. METHODS The Swedish National HIV Registry, the Swedish Population Registry and the Swedish National Cervical Screening Registry were linked to identify all women in Stockholm and Gothenburg counties (Sweden) living with HIV and diagnosed with CIN2+ sometime between 1983 and 2014 (n = 179). HIV-negative controls with CIN2+, were matched (2 : 1) for country of birth. CIN2+ biopsies were retrieved from biobanks and genotyped. Absolute risk and adjusted odds ratios (adjOR) of treatment failure by HIV status given HPV type (HPV16/18 vs. non-HPV16/18) were calculated. RESULTS HPV16 (32%) and HPV35 (24%) dominated in women living with HIV (WLWH) with failure, HPV35 mainly in women born in sub-Saharan Africa (67%). The absolute risk of failure in women with HPV16/18 was 26% [95% confidence interval (95% CI) 14-44] in WLWH and 12% in HIV-negative (95% CI 7-19). The absolute risk of failure in women with non-HPV16/18 was 20% (95% CI 12-31) in WLWH and 5% in HIV-negative (95% CI 2-11). WLWH with non-HPV16/18 were six times more likely to fail than HIV-negative (adjOR 6.1, 95% CI 2.0-18.6). CONCLUSION HPV35, not included in current HPV vaccines, was the second most common type in WLWH with failure. WLWH with non-HPV16/18 were six times more likely to fail than HIV-negative. This could have implications for surveillance and vaccination post CIN2+ treatment, particularly in WLWH from sub-Saharan Africa.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Uppsala
| | - Camilla Lagheden
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carina Eklund
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sara Nordqvist Kleppe
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mensur Dzabic
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philippe Wagner
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Uppsala
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics
| | - Joakim Dillner
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Carlander C, Lagheden C, Eklund C, Nordqvist Kleppe S, Dzabic M, Wagner P, Yilmaz A, Elfgren K, Sönnerborg A, Sparén P, Dillner J. HPV Types in Cervical Precancer by HIV Status and Birth Region: A Population-Based Register Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2662-2668. [PMID: 32967862 DOI: 10.1158/1055-9965.epi-20-0969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/01/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Data are lacking regarding which human papillomavirus (HPV) types cause high-grade cervical neoplasia (CIN2+) in people with HIV in Europe. We assessed which HPV types are associated with CIN2+ in women living in Sweden by HIV status. METHODS The Swedish National HIV Registry, the Swedish Population Registry, and the Swedish National Cervical Screening Registry were linked. CIN2+ tissue blocks of 130 women living with HIV (WLWH) and 234 HIV-negative women, matched for country of birth (1:2), were retrieved from bio-banks and HPV genotyped. Adjusted ORs (adjOR), stratified by country of birth, were calculated using conditional logistic regression. Matching was broken for cross-group comparisons. RESULTS WLWH with CIN2 were less likely to have HPV16 [14% vs. 40%; adjOR 0.1; 95% confidence interval (CI), 0.04-0.56] than HIV-negative women, but among women with CIN3, there was no difference in HPV16 prevalence by HIV status (adjOR 0.9; 95% CI, 0.51-1.70). WLWH were six times more likely to have HPV35 in CIN3 than HIV-negative women (adjOR 6.2; 95% CI, 1.3-30.4). WLWH from sub-Saharan Africa (SSA) had less 9-valent vaccine types, compared with both HIV-negative women born in Sweden (adjOR 0.1; 95% CI, 0.02-0.44) and WLWH born in Sweden (adjOR 0.1; 95% CI, 0.01-0.73), mostly because of decreased HPV16 and increased HPV35. CONCLUSIONS WLWH from SSA were less likely to be covered by the 9-valent vaccine, mostly due to less HPV16 and more HPV35. IMPACT This could have implications for HPV vaccines, currently not including HPV35, and for HPV-screening algorithms in women with origin from SSA.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. .,Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Lagheden
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carina Eklund
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sara Nordqvist Kleppe
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mensur Dzabic
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philippe Wagner
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Uppsala, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Elfgren
- CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Anders Sönnerborg
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Division of Clinical Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Eriksen J, Carlander C, Albert J, Flamholc L, Gisslén M, Navér L, Svedhem V, Yilmaz A, Sönnerborg A. Antiretroviral treatment for HIV infection: Swedish recommendations 2019. Infect Dis (Lond) 2020; 52:295-329. [PMID: 31928282 DOI: 10.1080/23744235.2019.1707867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Swedish Reference Group for Antiviral Therapy (RAV) published recommendations for the treatment of HIV infection in this journal most recently in 2017. An expert group under the guidance of RAV here provides updated recommendations. The most important updates in the present guidelines are the following: (a) The risk of HIV transmission through condomless sex from individuals with fully suppressed HIV viral load is effectively zero. (b) Pre-exposure prophylaxis (PrEP) is recommended for groups with a high risk of HIV infection. (c) Since the last update, two new substances have been registered: bictegravir and doravirine. (d) Dual treatment may be an alternative in selected patients, using lamivudine + dolutegravir or lamivudine + boosted darunavir/atazanavir. As with previous publications, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine. This document does not cover treatment of opportunistic infections and tumours.
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Affiliation(s)
- Jaran Eriksen
- Unit of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Carlander
- Department of Infectious Diseases, Västmanland County Hospital, Västerås, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Leo Flamholc
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Navér
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Veronica Svedhem
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Sohn AH, Kerr SJ, Hansudewechakul R, Gatechompol S, Chokephaibulkit K, Dang HLD, Tran DNH, Achalapong J, Teeratakulpisarn N, Chalermchockcharoenkit A, Thamkhantho M, Pankam T, Singtoroj T, Termrungruanglert W, Chaithongwongwatthana S, Phanuphak N. Risk Factors for Human Papillomavirus Infection and Abnormal Cervical Cytology Among Perinatally Human Immunodeficiency Virus-Infected and Uninfected Asian Youth. Clin Infect Dis 2019; 67:606-613. [PMID: 29617952 DOI: 10.1093/cid/ciy144] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/15/2018] [Indexed: 11/14/2022] Open
Abstract
Background Infection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)-infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency. Methods PHIV and HU females aged 12-24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses. Results Ninety-three PHIV and 99 HU adolescents (median age 19 [18-20] years) were enrolled (June 2013-July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392-808) cells/mm3, and 62% had a viral load <40 copies/mL. Across anogenital compartments, PHIV had higher rates of any HPV detected (80% vs 60%; P = .003) and any HR-HPV (60% vs 43%, P = .02). Higher proportions of PHIV had abnormal Pap smears (eg, atypical squamous cells of unknown significance [ASC-US], 12% vs 14%; low-grade squamous intraepithelial neoplastic lesions, 19% vs 1%). After adjusting for ever being pregnant and asymptomatic sexually transmitted infections (STI) at enrollment, PHIV were more likely to have HR-HPV than HU (odds ratio, 2.02; 95% confidence interval, 1.09-3.77; P = .03). Conclusions Perinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.
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Affiliation(s)
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
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Colie C, Michel KG, Massad L, Wang C, D’Souza G, Rahangdale L, Flowers L, Milam J, Palefsky JM, Minkoff H, Strickler HD, Kassaye SG. Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age. J Acquir Immune Defic Syndr 2018; 79:573-579. [PMID: 30272635 PMCID: PMC6231968 DOI: 10.1097/qai.0000000000001865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. METHODS Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. RESULTS Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4 T-cell count. In HIV-positive women, each increase of 100 CD4 T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. CONCLUSIONS CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.
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Affiliation(s)
- Christine Colie
- Georgetown University School of Medicine, Washington, DC, USA
| | | | | | - Cuiwei Wang
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Lisa Rahangdale
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA, USA
| | - Joel Milam
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia. AIDS 2018; 32:1475-1484. [PMID: 29746299 DOI: 10.1097/qad.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess if women living with HIV (WLWH) have poorer outcome after treatment of cervical intraepithelial neoplasia grade 2, grade 3, adenocarcinoma in situ or cervical cancer (CIN2+) than HIV-negative women (HNW) and to identify predictors of CIN2+ treatment failure and recurrence in WLWH. DESIGN Population-based cohort study with follow-up between 1983 and 2015. METHODS The Swedish National HIV Registry, the Swedish Population Registry and the Swedish National Cervical Screening Registry were linked to identify all women in Stockholm and Gothenburg counties (Sweden) living with HIV and diagnosed with CIN2+ (n = 179) sometime between 1983 and 2014. For each WLWH, two HNW resident in the same counties and matched for country of birth, diagnosed with CIN2+, were chosen as controls. Treatment failure was defined as the presence of CIN2+ at initial follow-up. Recurrence was defined as the presence of CIN1+ subsequent to an initial normal follow-up. RESULTS WLWH were three times more likely to have treatment failure (odds ratio (OR) 3.7 [95% confidence interval (CI) 2.0-6.8]) and five times more likely to recur (hazard ratio 5.0 [95% CI 2.1-11.6]) than HNW. Suppressive antiretroviral therapy (ART) at time of treatment of CIN2+ was associated with reduced OR of treatment failure (OR 0.3 [95% CI 0.1-0.8]). Immunosuppression (CD4 cell count <200 cells/μl) associated strongly with treatment failure (OR compared with CD4 cell count ≥500: 8.5 [95% CI 2.3-30.7]). CONCLUSION Suppressive ART is associated with effective treatment of CIN2+. Early HIV diagnosis and ART are essential for successful CIN2+ treatment.
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Franceschi S, Clifford GM. Cervical screening: toward an equal risk/equal management approach, irrespective of HIV status. AIDS 2017; 31:1045-1046. [PMID: 28350579 DOI: 10.1097/qad.0000000000001453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carlander C, Marrone G, Brännström J, Yilmaz A, Elfgren K, Sparén P, Sönnerborg A. Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study. BJOG 2017; 124:1680-1687. [PMID: 28235246 DOI: 10.1111/1471-0528.14614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing. DESIGN Population-based register study. SETTING Counties of Stockholm and Gothenburg, Sweden, 1990-2014. POPULATION All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx). METHODS Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+ compared with women with a normal/mildly abnormal cytology/histology was assessed. MAIN OUTCOME MEASURES Proportion of women with undiagnosed HIV. RESULTS The proportion of undiagnosed HIV was higher among all women with CIN2+ than among those without CIN2+ : 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+ had a significantly lower nadir CD4+ T-cell count, as a measure of immunosuppression, compared with women without CIN2+ before HIV diagnosis (median nadir CD4, 95 cells/mm3 versus 210 cells/mm3 ; P < 0.01). CONCLUSIONS HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+ . TWEETABLE ABSTRACT HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+ .
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Affiliation(s)
- C Carlander
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - G Marrone
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - J Brännström
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Elfgren
- CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - P Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Sönnerborg
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Eriksen J, Albert J, Blaxhult A, Carlander C, Flamholc L, Gisslén M, Josephson F, Karlström O, Navér L, Svedhem V, Yilmaz A, Sönnerborg A. Antiretroviral treatment for HIV infection: Swedish recommendations 2016. Infect Dis (Lond) 2016; 49:1-34. [PMID: 27804313 DOI: 10.1080/23744235.2016.1247495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The Swedish Medical Products Agency and the Swedish Reference Group for Antiviral Therapy (RAV) have jointly published recommendations for the treatment of HIV infection on seven previous occasions (2002, 2003, 2005, 2007, 2009, 2011 and 2014). In February 2016, an expert group under the guidance of RAV once more revised the guidelines. The most important updates in the present guidelines are as follows: Tenofovir alafenamide (TAF) has recently been registered. TAF has several advantages over tenofovir disoproxilfumarate (TDF) and is recommended instead of TDF in most cases. First-line treatment for previously untreated individuals includes dolutegravir, boosted darunavir or efavirenz with either abacavir/lamivudine or tenofovir (TDF/TAF)/emtricitabine. Pre-exposure prophylaxis (PrEP) is recommended for high-risk individuals. As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine ( http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ ) ( Table 1 ). This document does not cover treatment of opportunistic infections and tumours. [Table: see text].
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Affiliation(s)
- Jaran Eriksen
- a Department of Clinical Pharmacology , Karolinska University Hospital and Division of Clinical Pharmacology and Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Jan Albert
- b Department of Microbiology, Tumor and Cell Biology , Karolinska Institutet and Department of Clinical Microbiology, Karolinska University Hospital , Stockholm , Sweden
| | - Anders Blaxhult
- c Venhälsan, Södersjukhuset and The Swedish Agency for Public Health , Stockholm , Sweden
| | - Christina Carlander
- d Clinic of Infectious Diseases , Västmanland County Hospital , Västerås , Sweden
| | - Leo Flamholc
- e Department of Infectious Diseases , Skåne University Hospital , Malmö , Sweden
| | - Magnus Gisslén
- f Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Sweden
| | | | - Olof Karlström
- h The Swedish Medical Products Agency, Uppsala and Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Lars Navér
- i Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden
| | - Veronica Svedhem
- j Department of Infectious Diseases , Karolinska University Hospital and Division of Infectious Diseases and Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden
| | - Aylin Yilmaz
- k Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Anders Sönnerborg
- l Division of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden ; All members of the Swedish Reference Group for Antiviral Therapy
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