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Piyathilake CJ, Kumar R, Crowley MR, Badiga S, Burkholder GA. Human papillomavirus sequencing reveals its usefulness for the management of HIV-infected women at risk for developing cervical cancer. J Obstet Gynaecol Res 2021; 47:2185-2195. [PMID: 33754434 DOI: 10.1111/jog.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
AIM Next-generation sequencing (NGS) is able to describe the composition of human papillomaviruses (HPVs) as percent (%) reads rather than positive/negative results. Therefore, we used this unique approach to assess the prevalence of cervical HPVs of HIV infected (HIV+) in order to understand the determinants of being infected with higher % reads of high risk (HR)-HPVs and cervical abnormalities of atypical squamous cells of unknown significance or higher (ASCUS+). METHODS Study included 66 women characterized for relevant risk factors/cytology. Receiver-operating curve curve was used to derive the optimal % read cut point to identify ASCUS+ in relation to any HR-HPV genotype or other specific HPV genotypes. The determinants of ASCUS+ and HR-HPVs were tested using logistic regression. RESULTS Women with >20% reads of any HR-HPV or >12% any HR-HPV other than HPV 16/18 were 5.7 and 12.6 times more likely to be diagnosed with ASCUS+, respectively. Lower CD4 count was a significant determinant of >20% reads of HR-HPV (odds ratio [OR] = 4.1) or >12% any HR-HPV other than HPV 16/18 (OR = 4.5). CONCLUSION We envision that the NGS-based HPV detection will be more accurate for screening and management of HIV+ at risk for developing cervical cancer (CC). We raise concerns regarding the limitations of 16/18-based HPV testing for triage and the efficacy of current HPV vaccines for preventing CC in HIV+.
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Affiliation(s)
- Chandrika J Piyathilake
- Department of Nutrition Sciences, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Ranjit Kumar
- UAB Center for Clinical & Translational Science, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Michael R Crowley
- Department of Genetics, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Suguna Badiga
- Department of Nutrition Sciences, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Greer A Burkholder
- Department of Medicine, Division of Infectious Diseases, The University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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2
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Tong Y, Tonui P, Ermel A, Orang’o O, Wong N, Titus M, Kiptoo S, Muthoka K, Loehrer PJ, Brown DR. Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women. SAGE Open Med 2020; 8:2050312120945138. [PMID: 32782796 PMCID: PMC7388102 DOI: 10.1177/2050312120945138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Cervical cancer is caused by persistent infection with oncogenic, or "high-risk" types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia. METHODS Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic and behavioral characteristics. RESULTS HIV-infected women were older and less likely to be married and to own a home and had more lifetime sexual partners than HIV-uninfected women. All HIV-infected women were receiving anti-retroviral therapy at enrollment and had satisfactory CD4 cell counts and HIV viral loads. One- and two-year persistent human papillomavirus detection was significantly associated with HIV infection for any human papillomavirus, high-risk human papillomavirus, International Agency for the Research on Cancer-classified high-risk human papillomavirus, and non-oncogenic "low-risk" human papillomavirus. CONCLUSION Persistent detection of oncogenic and non-oncogenic human papillomavirus was strongly associated with HIV infection in Kenyan women with re-constituted immune systems based on satisfactory CD4 cell counts. In addition to HIV infection, factors associated with an increased risk of human papillomavirus persistence included a higher number of lifetime sex partners. Factors associated with decreased risk of human papillomavirus persistence included older age and being married. Further studies are needed to identify the immunological defects in HIV-infected women that allow human papillomavirus persistence, even in women receiving effective anti-retroviral therapy. Further studies are also needed to determine the significance of low-risk human papillomavirus persistence in HIV-infected women.
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Affiliation(s)
- Yan Tong
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | - Aaron Ermel
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | - Nelson Wong
- Indiana University School of Medicine,
Indianapolis, IN, USA
| | | | | | | | | | - Darron R Brown
- Indiana University School of Medicine,
Indianapolis, IN, USA
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3
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Thorsteinsson K, Ladelund S, Storgaard M, Katzenstein TL, Johansen IS, Pedersen G, Rönsholt FF, Nielsen LN, Nilas L, Franzmann M, Obel N, Lebech AM, Bonde J. Persistence of cervical high-risk human papillomavirus in women living with HIV in Denmark - the SHADE. BMC Infect Dis 2019; 19:740. [PMID: 31438877 PMCID: PMC6706931 DOI: 10.1186/s12879-019-4377-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Women living with HIV (WLWH) have high rates of persistent high-risk human papillomavirus (hrHPV) infections and cervical cancer. We aimed to assess the distribution of hrHPV genotypes, risk factors of type-specific hrHPV persistence, and high-grade squamous intraepithelial lesions or worse (≥HSIL) in WLWH in Denmark. Methods From the prospective Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) we identified WLWH with a positive hrHPV test during the study period; 2011–2014. HIV demographics were retrieved from the Danish HIV Cohort Study and pathology results from the The Danish Pathology Data Bank. Logistic regression was used to identify risk factors associated with persistent hrHPV infection (positivity of the same hrHPV type in two samples one-two years after the first hrHPV positive date) and ≥ HSIL. Results Of 71 WLWH, 31 (43.7%) had persistent hrHPV infection. Predominant hrHPV genotypes were HPV58, 52, 51, and 35 and most frequently observed persistent genotypes were HPV52, 33 and 31. CD4 < 350 cells/μL predicted genotype-specific hrHPV persistence (adjusted OR 4.36 (95%CI: 1.18–16.04)) and ≥ HSIL was predicted by prior AIDS (adjusted OR 8.55 (95% CI 1.21–60.28)). Conclusions This prospective cohort study of well-treated WLWH in Denmark found a high rate of persistent hrHPV infections with predominantly non-16/18 hrHPV genotypes. CD4 count < 350 cells/μL predicted hrHPV persistence, while prior AIDS predicted ≥HSIL. Electronic supplementary material The online version of this article (10.1186/s12879-019-4377-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristina Thorsteinsson
- Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
| | - Steen Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Lisbeth Nilas
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Franzmann
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
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4
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El Chaer F, El Sahly HM. Vaccination in the Adult Patient Infected with HIV: A Review of Vaccine Efficacy and Immunogenicity. Am J Med 2019; 132:437-446. [PMID: 30611828 DOI: 10.1016/j.amjmed.2018.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022]
Abstract
Patients infected with HIV remain at increased risk of mortality and morbidity from diseases that are preventable with vaccines partly due to the persisting immunopathology that results in impaired responses to vaccination despite virologic suppression. Because data on clinical effectiveness in patients who are immunocompromised remain limited, undervaccination of individuals with HIV poses a major concern. Multiple societies have published recommendations on vaccination in individuals infected with HIV. Many of these recommendations are based on extrapolation of data from clinical trials that usually exclude patients with HIV, although there is a growing body of data from patients infected with HIV as well. In this review, we describe the available literature on vaccine response in the adult patient with HIV as measured by immunogenicity or vaccine efficacy.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, University of Maryland School of Medicine, Baltimore; University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Tx.
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5
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Abstract
Human papillomavirus (HPV) is the first identified necessary cause of human cancers and is associated with nearly 100% of all cervical cancers. Compared to the general female populations, HIV+ women have higher prevalence and incidence of cervical HPV infections, higher risks of persistent HPV infections and subsequent cervical intraepithelial lesions, and a higher incidence of cervical cancer. Although the wide use of combined antiretroviral therapy (cART) has improved the immune function and the longevity of HIV+ women, the incidence of cervical cancer in HIV+ women has not declined. For HIV+ women who follow routine cervical cancer screenings, their incidence of cervical cancer is comparable to that in HIV-negative women. Thus, adherence to the recommended cervical cancer screening is still critical for HIV+ women to prevent cervical cancer. Prophylactic HPV vaccines may also benefit HIV+ women, but prospective studies are needed to determine the effectiveness of HPV vaccination on reducing cervical cancer incidence in HIV+ women.
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Affiliation(s)
- Ping Du
- Department of Medicine, Department of Public Health Sciences, Penn State Hershey College of Medicine, 90 Hope Drive, Suite 2200, A210, Hershey, PA, USA.
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6
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Ermel A, Shew ML, Imburgia TM, Brown M, Qadadri B, Tong Y, Brown DR. Redetection of human papillomavirus type 16 infections of the cervix in mid-adult life. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 5:75-79. [PMID: 29355777 PMCID: PMC5886910 DOI: 10.1016/j.pvr.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess whether HPV 16 originally detected in adolescent women can be redetected in adulthood. METHODS A convenience sample of 27 adult women with known HPV 16 detection during adolescence was assessed for HPV 16 redetection. A comparison of the long control region (LCR) DNA sequences was performed on some of the original and redetected HPV 16 isolates. RESULTS Median age at reenrollment was 27.5 years (interquartile range of 26.7-29.6). Reenrollment occurred six years on average after the original HPV 16 detection. Eleven of 27 women had HPV 16 redetected. Some of these HPV 16 infections had apparently cleared during adolescence. LCR sequencing was successful in paired isolates from 6 women; in 5 of 6 cases the redetected HPV 16 isolates were identical to those detected during adolescence, CONCLUSIONS: HPV 16 may be episodically detected in young women, even over long time periods. HPV 16 redetection with identical LCR sequences suggests low-level persistent infection rather than true clearance, although newly acquired infection with an identical HPV 16 isolate cannot be excluded. However, this study suggests that a new HPV 16-positive test in a clinical setting may not indicate a new infection.
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Affiliation(s)
- Aaron Ermel
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Marcia L Shew
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Teresa M Imburgia
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Matt Brown
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Brahim Qadadri
- Department of Internal Medicine, Indiana University School of Medicine, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, USA
| | - Darron R Brown
- Department of Internal Medicine, Indiana University School of Medicine, USA; Department of Immunology and Microbiology, Indiana University School of Medicine, USA.
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7
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Kelly H, Weiss HA, Benavente Y, de Sanjose S, Mayaud P. Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis. Lancet HIV 2017; 5:e45-e58. [PMID: 29107561 PMCID: PMC5757426 DOI: 10.1016/s2352-3018(17)30149-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/15/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes. METHODS We did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I2 statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546). FINDINGS We identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0·83, 95% CI 0·70-0·99; I2=51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0·65, 0·40-1·06; I2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0·59, 0·40-0·87; I2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0·64, 95% CI 0·54-0·75; I2=18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1·54, 1·30-1·82; I2=0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0·40, 95% CI 0·18-0·87, I2=33%). INTERPRETATION Early ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect. FUNDING UK Medical Research Council.
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Affiliation(s)
- Helen Kelly
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Helen Kelly, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKCorrespondence to: Dr Helen Kelly, Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolanda Benavente
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Chikandiwa A, Chimoyi L, Pisa PT, Chersich MF, Muller EE, Michelow P, Mayaud P, Delany-Moretlwe S. Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study. BMC Public Health 2017; 17:425. [PMID: 28832285 PMCID: PMC5498864 DOI: 10.1186/s12889-017-4354-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Persistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs. METHODS We enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models. RESULTS Two thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15-58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02-5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42-11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57-125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60-10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63-29.20) and having a CD4+ count <200 cells/μL (aOR = 5.48; 95%CI: 1.60-18.78) were associated with having AGWs. CONCLUSIONS In this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.
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Affiliation(s)
- Admire Chikandiwa
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucy Chimoyi
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pedro T Pisa
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Etienne E Muller
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Michelow
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Anatomical Pathology, Cytology Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Philippe Mayaud
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Individuals with inherited immunodeficiencies, autoimmune disorders, organ or bone marrow transplantation, or infection with human immunodeficiency virus (HIV) are at increased risk of infection with both low-risk and high-risk human papillomavirus (HPV) types. Chronic immunosuppression provides an environment for persistent HPV infection which carries a higher risk of malignant transformation. Screening guidelines have been developed or advocated for processes that have detectable premalignant lesions, such as anal cancer or cervical cancer. For other anatomic locations, such as cutaneous, penile, and oropharyngeal, a biopsy of suspicious lesions is necessary for diagnosis. HPV cannot be cultured from clinical specimens in the laboratory, and diagnosis relies on cytologic, histologic, or molecular methods.
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10
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Gaspar J, Quintana SM, Reis RK, Gir E. Sociodemographic and clinical factors of women with HPV and their association with HIV. Rev Lat Am Enfermagem 2017; 23:74-81. [PMID: 25806634 PMCID: PMC4376034 DOI: 10.1590/0104-1169.3364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/29/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: to identify the association between HIV-seropositive or HIV-seronegative status
and the sociodemographic and clinical variables of women with genital HPV
infection. METHOD: cross-sectional, retrospective study in a reference service in Ribeirão Preto. A
total of 824 women undergoing HIV testing who had high or low grade cervical
intraepithelial lesions or condylomatous genital lesions caused by HPV were
studied. The chi-square test and logistic regression analysis with the calculation
of the odds ratio and a confidence interval of 95% were conducted to verify the
association. RESULTS: a higher probability of seropositivity was identified for non-white women; with
low education; widowed; who consumed alcohol, tobacco or illicit drugs; with
hepatitis C; who had multiple partners; and that worked as prostitutes. CONCLUSION: the increasing impairment of women due to sexually transmitted infections,
considering the influence of the socioeconomic and behavioral context on the
course of these infections, highlights the importance of public policies that
establish intervention strategies involving the prevention, early diagnosis and
timely treatment of these diseases, so that there is the promotion of quality of
life in this population.
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Affiliation(s)
- Joice Gaspar
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Silvana Maria Quintana
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Elucir Gir
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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11
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Keeshin SW, Feinberg J. Text Message Reminder-Recall to Increase HPV Immunization in Young HIV-1-Infected Patients. J Int Assoc Provid AIDS Care 2016; 16:110-113. [PMID: 28325131 PMCID: PMC5513148 DOI: 10.1177/2325957416682302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
HIV infected patients have higher rates of HPV infection, worse disease progression, increase severity of disease, and are at higher risk for intraepithelial neoplasia and cancer than their HIV negative counterparts. We conducted a yearlong pilot project to evaluate the impact of text message HPV immunization reminder-recall in young HIV-1 positive patients in a large urban academic HIV clinic. We found that text message reminder-recall improved HPV immunization uptake in a young, primarily black and un- or under-insured HIV-1 infected patients. As communication by texting is characteristic of teens and young adults in the general population, text message reminder-recalls should be considered a viable option to improve vaccination rates among young HIV patients.
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Affiliation(s)
- Susana Williams Keeshin
- 1 Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah College of Medicine, Salt Lake City, UT, USA
| | - Judith Feinberg
- 2 Department of Behavioral Medicine and Psychiatry, West Virginia University, School of Medicine, Morgantown, WV, USA
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12
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Murphy J, Mark H, Anderson J, Farley J, Allen J. A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV. J Low Genit Tract Dis 2016; 20:139-44. [PMID: 27015260 PMCID: PMC4808515 DOI: 10.1097/lgt.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Women living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV. MATERIALS AND METHODS This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer. RESULTS A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. CONCLUSIONS The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.
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13
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Abstract
High-risk human papillomaviruses (HPVs) cause essentially all cervical cancers, most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile cancers. Improved understanding of the pathogenesis of infection and the availability of newer tests are changing the approach to screening and diagnosis. Molecular tests to detect DNA from the most common high-risk HPVs are FDA approved for use in conjunction with cytology in cervical cancer screening programs. More-specific tests that detect RNA from high-risk HPV types are now also available. The use of molecular tests as the primary screening tests is being adopted in some areas. Genotyping to identify HPV16 and -18 has a recommended role in triaging patients for colposcopy who are high-risk HPV positive but have normal cytology. There are currently no recommended screening methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV testing has limited utility in patients at high risk for anal cancer, but p16 immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens that show moderate dysplasia or precancer mimics. HPV testing is recommended for oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research will help to improve the content of future guidelines for screening and diagnostic testing.
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Affiliation(s)
- Eileen M Burd
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, and Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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Kojic EM, Rana AI, Cu-Uvin S. Human papillomavirus vaccination in HIV-infected women: need for increased coverage. Expert Rev Vaccines 2015; 15:105-17. [PMID: 26599305 DOI: 10.1586/14760584.2016.1110025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Human immunodeficiency virus (HIV)-infected women carry a significant burden on human papillomavirus (HPV) infection and associated diseases. As HIV-infected individuals are living longer, the prevalence of HPV infection is rising and HPV-associated cytological abnormalities remain high despite successful treatments of HIV infection. Several HPV vaccines are currently available and recommended for adolescents and adults up to age 26. The vaccines are safe, immunogenic and effective in preventing diseases due to HPV types included in the vaccines, particularly among persons without prior HPV exposure. This review summarizes available data on the use of the HPV vaccines among HIV-infected women. The immunogenicity and safety of the vaccines are highlighted and in particular, barriers to vaccination among HIV-infected women are discussed.
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Affiliation(s)
- Erna Milunka Kojic
- a Division of Infectious Diseases , Warren Alpert School of Medicine, Brown University , Providence , RI , USA
| | - Aadia I Rana
- a Division of Infectious Diseases , Warren Alpert School of Medicine, Brown University , Providence , RI , USA
| | - Susan Cu-Uvin
- a Division of Infectious Diseases , Warren Alpert School of Medicine, Brown University , Providence , RI , USA
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Kelly H, Mayaud P, de Sanjose S. Concomitant Infection of HIV and HPV: What Are the Consequences? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0132-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shew ML, Ermel AC, Tong Y, Tu W, Qadadri B, Brown DR. Episodic detection of human papillomavirus within a longitudinal cohort of young women. J Med Virol 2015; 87:2122-9. [PMID: 26112742 DOI: 10.1002/jmv.24284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 12/26/2022]
Abstract
Redetection of a type-specific human papillomavirus (HPV) infection may represent reinfection. However, a growing body of literature suggests that reactivation of HPV is common and that episodic detection of a HPV infection may represent reactivation of a persistent virus. A cohort of prospectively followed adolescent women (N = 150), ages 14-17, was observed on average 6.4 years. The authors describe the redetection of 37 HPV types and associated factors of redetection of high-risk (HR) and low-risk (LR) types using Cox proportional hazard models. Of 1,248 HPV type-specific infections, 286 (22.9%) were associated with redetection after apparent clearance. Chlamydia infections (HR = 1.99 [95%CI, 1.15-3.49]) and non-condom use (HR = 1.1 [95%CI, 1.04-1.99]) were associated with increased redetection of HR-HPV infections. Oral contraceptive pills (HR = 2.73 [95%CI, 1.52-4.90]) and number of sexual partners (HR = 1.44 [95%CI, 1.04-1.99]) were associated with increased redetection of LR-HPV infections. Episodic detection of HPV is common for HR- and LR-HPV types. This finding and identified factors or redetection have clinical implications and enhances the understanding of HPV natural history.
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Affiliation(s)
- Marcia L Shew
- Departments of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron C Ermel
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yan Tong
- Departments of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wanzhu Tu
- Departments of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brahim Qadadri
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Darron R Brown
- Departments of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Departments of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
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Castilho JL, Levi JE, Luz PM, Cambou MC, Vanni T, de Andrade A, Derrico M, Veloso VG, Grinsztejn B, Friedman RK. A cross-sectional study of high-risk human papillomavirus clustering and cervical outcomes in HIV-infected women in Rio de Janeiro, Brazil. BMC Cancer 2015; 15:478. [PMID: 26100400 PMCID: PMC4477502 DOI: 10.1186/s12885-015-1486-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/09/2015] [Indexed: 01/22/2023] Open
Abstract
Background In Brazil, the rate of cervical cancer remains high despite the availability of screening programs. With ongoing vaccine development and implementation, information on the prevalence of specific HPV types is needed, particularly among high-risk populations, such as HIV-infected women. Methods We performed a study of HIV-infected women in Rio de Janeiro, Brazil, who underwent cervical HPV genotype testing between 2005-2013. We examined the prevalence of high-risk HPV types and the patterns of high-risk HPV type clustering. Using logarithmic binomial regression, we estimated the risk of abnormal cytology by HPV genotype result. Results Of the 562 women included, 498 (89 %) had at least one HPV type detected. 364 women (65 %) had at least one high-risk HPV type detected and 181 (32 %) had more than one high-risk type detected. HPV 58 was the most frequent HPV type detected overall (prevalence 19.8 % [95 % confidence interval 16.4–23.1]), followed by HPV 53 (prevalence 15.5 % [12.5–18.5]) and HPV 16 (prevalence 13 % [10.2–15.8]). Women infected with more than one high-risk HPV type were younger, had lower CD4+ lymphocyte counts, and were more likely to be infected with HPV 16 or 18. In adjusted analyses, presence of more than one high-risk HPV type was associated with a two-fold increased risk of abnormal cytology after adjusting for presence of individual high-risk type, age, and CD4+ lymphocyte count (adjusted prevalence ratios 1.88–2.07, all p <0.001). No single high-risk HPV type was statistically associated with abnormal cytology after adjusting for the presence of more than one high-risk HPV type. Conclusions In the largest study of cervical HPV genotypes among HIV-infected women in Latin America, infection by high-risk HPV types other than 16 or 18 and infection by more than one high-risk HPV types were common. Infection by more than one high-risk type was more strongly associated with abnormal cervical cytology than any individual high-risk HPV type, highlighting the need for multi-valent HPV vaccines.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, USA.
| | - José Eduardo Levi
- Virology Lab, Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil.
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Mary Catherine Cambou
- Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Tazio Vanni
- Departamento de Ciência e Tecnologia, Ministério da Saúde, Brasília, Brazil.
| | - Angela de Andrade
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Mônica Derrico
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Hanisch RA, Cherne SL, Sow PS, Winer RL, Hughes JP, Feng Q, Gottlieb GS, Toure M, Dem A, Kiviat NB, Hawes SE. Human papillomavirus type 16 viral load in relation to HIV infection, cervical neoplasia and cancer in Senegal. Cancer Epidemiol 2014; 38:369-75. [PMID: 24852136 DOI: 10.1016/j.canep.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/01/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of human papillomavirus (HPV) viral load in the pathogenesis of cervical cancer among HIV-infected and HIV-uninfected women has not yet been established. METHODS In this cross-sectional study, HPV-16 viral loads were measured using previously-collected and frozen cervical swab samples from 498 HPV-16 positive Senegalese women (368 HIV-seronegative, 126 HIV-1 and/or HIV-2 seropositive). The real-time polymerase chain reaction assay was used to quantify HPV-16 E7 copy number normalized by human cellular DNA (β-actin), and viral loads were log10 transformed. Associations between HPV-16 viral load, degree of cervical abnormality, and HIV status were assessed using multinomial and linear regression methods. RESULTS Compared to women with normal cytology, the likelihood of CIN1 (ORa: 1.21, 95% CI 0.93-1.57), CIN2-3 (ORa: 2.38, 95% CI 1.72-3.29) and cancer (ORa: 2.12, 95% CI 1.52-2.96) was found to increase for each 1-unit log10 increase in HPV-16 viral load. Compared to HIV-negative women, HIV-positive women had higher average HPV-16 viral load values (βa: 0.39, 95% CI 0.03-0.75), even after accounting for degree of cervical abnormality. CONCLUSION In our study of women including those with cancer, HPV-16 viral load was associated with a higher likelihood of cervical abnormalities. However, substantial overlaps across categories of disease severity existed. Higher viral load among HIV-infected individuals may indicate that HIV infection influences HPV viral replication factors.
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Affiliation(s)
- Rachel A Hanisch
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA; International Agency for Research on Cancer, Section of Environment and Radiation, 150 Cours Albert Thomas, Lyon Cedex 08 69372, France.
| | - Stephen L Cherne
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Papa Salif Sow
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Rachel L Winer
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Qinghua Feng
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases and Department of Global Health, School of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Macoumba Toure
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Ahmadou Dem
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Nancy B Kiviat
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA
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Ermel A, Ramogola-Masire D, Zetola N, Tong Y, Qadadri B, Azar MM, Brown DR. Invasive cervical cancers from women living in the United States or Botswana: differences in human papillomavirus type distribution. Infect Agent Cancer 2014; 9:22. [PMID: 25053972 PMCID: PMC4105511 DOI: 10.1186/1750-9378-9-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/29/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cervical cancer is the primary cause of cancer-related deaths in women living in Botswana. METHODS Paraffin-embedded blocks of formalin-fixed invasive cervical cancer specimens were identified from women living in the U.S. (n = 50) or Botswana (n = 171) from which DNA was extracted. Thin-section PCR was performed on each sample for HPV types and HIV. Comparisons were made between HPV types and groups of types identified in cancers. RESULTS HPV DNA was identified in 92.0% of specimens from the U.S. containing amplifiable human DNA, and 79.5% of specimens from Botswana. HPV 16 was detected in 40 of 46 HPV-positive specimens (87.0%) from the U.S. vs. 58 of 136 (42.7%) from Botswana (p < 0.001). In contrast, non-HPV 16/18 types, all A9 species (HPV16, 31, 33, 35, 52, and 58), non-HPV 16 A9 (HPV 31, 33, 35, 52, and 58), HPV 18, all A7 types (18, 39, 45, 59, and 68) types were detected significantly more often in specimens from Botswana. The prevalence of non-HPV 18 A7 types did not differ significantly between the two groups. For specimens from Botswana, 31.6% contained PCR-amplifiable HIV sequences, compared to 3.9% in U.S. specimens. Stratifying the samples from Botswana by HIV status, HPV 31 was detected significantly more often in HIV-positive specimens. Other HPV types and groups of types were not significantly different between HIV-positive and HIV-negative specimens from Botswana. CONCLUSION This study demonstrates that there may be important HPV type differences in invasive cervical cancers occurring in women living in the United States or Botswana. Factors in addition to HIV may be driving these differences.
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Affiliation(s)
- Aaron Ermel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Nicola Zetola
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brahim Qadadri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marwan M Azar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Darron R Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
- Microbiology and Immunology, Division of Infectious Diseases, Indiana University School of Medicine, 635 Barnhill Drive, Room MS 224, Indianapolis, IN 46202, USA
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Jaquet A, Horo A, Ekouevi DK, Toure B, Coffie PA, Effi B, Lenaud S, Messou E, Minga A, Sasco AJ, Dabis F. Risk factors for cervical intraepithelial neoplasia in HIV-infected women on antiretroviral treatment in Côte d'Ivoire, West Africa. PLoS One 2014; 9:e90625. [PMID: 24595037 PMCID: PMC3942459 DOI: 10.1371/journal.pone.0090625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/01/2014] [Indexed: 12/26/2022] Open
Abstract
Background Facing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN) in HIV-infected women is of paramount importance. Methods A cervical cancer screening based on visual inspection methods was proposed to HIV-infected women in care in Abidjan, Côte d'Ivoire. Positively screened women were referred for a colposcopy to a gynaecologist who performed directed biopsies. Results Of the 2,998 HIV-infected women enrolled, 132 (4.4%) CIN of any grade (CIN+) were identified. Women had been followed-up for a median duration of three years [IQR: 1–5] and 76% were on antiretroviral treatment (ART). Their median most recent CD4 count was 452 [IQR: 301–621] cells/mm3. In multivariate analysis, CIN+ was associated with a most recent CD4 count >350 cells/mm3 (OR: 0.3; 95% CI: 0.2–0.6) or ≥200–350 cells/mm3 (OR 0.6; 95% CI 0.4–1.0) (Ref: <200 cells/mm3 CD4) (p<10−4). Conclusions The presence of CIN+ is less common among HIV-infected women with limited or no immune deficiency. Despite the potential impact of immunological recovery on the reduction of premalignant cervical lesions through the use of ART, cervical cancer prevention, including screening and vaccination remains a priority in West Africa while ART is rolled-out.
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Affiliation(s)
- Antoine Jaquet
- Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- * E-mail:
| | - Apollinaire Horo
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire
| | - Didier K. Ekouevi
- Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Badian Toure
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Benjamin Effi
- Service d'Anatomo-Pathologie, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Severin Lenaud
- Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | - Albert Minga
- Centre Médical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, Abidjan, Cote d'Ivoire
| | - Annie J. Sasco
- Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - François Dabis
- Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
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Cespedes MS, Kerns SL, Holzman RS, McLaren PJ, Ostrer H, Aberg JA. Genetic predictors of cervical dysplasia in African American HIV-infected women: ACTG DACS 268. HIV CLINICAL TRIALS 2013; 14:292-302. [PMID: 24334182 DOI: 10.1310/hct1406-292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine genome-wide associations in HIV-infected women with a history of cervical dysplasia compared with HIV-infected women with no history of abnormal Papanicolaou (Pap) tests. DESIGN Case-control study using data from women analyzed for the HIV Controllers Study and enrolled in HIV treatment-naïve studies in the AIDS Clinical Trials Group (ACTG). METHODS Genotyping utilized Illumina HumanHap 650 Y or 1MDuo platforms. After quality control and principal component analysis, ~610,000 significant single nucleotide polymorphisms (SNPs) were tested for association. Threshold for significance was P < 5 × 10(-8) for genome-wide associations. RESULTS No significant genomic association was observed between women with low-grade dysplasia and controls. The genome-wide association study (GWAS) analysis between women with high-grade dysplasia or invasive cervical cancer and normal controls identified significant SNPs. In the analyses limited to African American women, 11 SNPs were significantly associated with the development of high-grade dysplasia or cancer after correcting for multiple comparisons. The model using significant SNPs alone had improved accuracy in predicting high-grade dysplasia in African American women compared to the use of clinical data (area under the receiver operating characteristic curve for genetic and clinical model = 0.9 and 0.747, respectively). CONCLUSIONS These preliminary data serve as proof of concept that there may be a genetic predisposition to developing high-grade cervical dysplasia in African American HIV-infected women. Given the small sample size, the results need to be validated in a separate cohort.
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Affiliation(s)
| | | | | | - Paul J McLaren
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Harry Ostrer
- Albert Einstein College of Medicine, Bronx, New York
| | - Judith A Aberg
- New York University School of Medicine, New York, New York
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Patrelli TS, Gizzo S, Peri F, Franchi L, Volpi L, Esposito F, Pedrazzi G, Antoni AD, Modena AB. Impact of Highly Active Antiretroviral Therapy on the Natural History of Cervical Precancerous Lesions: A 17-Year Institutional Longitudinal Cohort Study. Reprod Sci 2013; 21:837-845. [PMID: 24336675 DOI: 10.1177/1933719113512531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We performed an observational cohort study in order to assess the correlation between precancerous cervical lesions (cervical intraepithelial neoplasia [CIN]) and immunological state in human immunodeficiency virus (HIV)-positive women treated by highly active antiretroviral therapy (HAART). We analyzed 194 HIV-infected women referred to the Parma-Universitary Hospital for early detection of human papilloma virus-induced CINs. We analyzed cytology, colposcopy, and CIN degree according to HAART: group A untreated and group B treated. We compared the CD4+ count and viral load at the time of CIN onset and the time interval between diagnosis of HIV and the onset of CIN. Group A and group B showed homogeneous results for general features, CD4+ count, viral load, and Papanicolaou test features. Differences were not found in terms of histology and CD4+ value, viral load count, pharmacological treatment, years since the diagnosis of HIV, age, smoking, sexual promiscuity, previous intravenous narcotics abuse, prostitution, sexually transmitted diseases, ethnicity, and age at diagnosis. Histology and the clinical stage of HIV showed significant concordances between the high degree of cervical dysplasia and advanced stage of HIV disease.
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Affiliation(s)
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Francesca Peri
- Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Laura Franchi
- Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Lavinia Volpi
- Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Federica Esposito
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Anna Degli Antoni
- Division of Infectious Diseases and Hepatology, University of Parma, Parma, Italy
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Hanisch RA, Sow PS, Toure M, Dem A, Dembele B, Toure P, Winer RL, Hughes JP, Gottlieb GS, Feng Q, Kiviat NB, Hawes SE. Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa. J Clin Virol 2013; 58:696-702. [PMID: 24210330 DOI: 10.1016/j.jcv.2013.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/16/2013] [Accepted: 10/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons. OBJECTIVES To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal. STUDY DESIGN Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated. RESULTS The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/μl or above. CONCLUSION HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.
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Affiliation(s)
- R A Hanisch
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA; International Agency for Research on Cancer, Section of Environment and Radiation, 150 Cours Albert Thomas, Lyon, 69372 Cedex 08, France.
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Tong Y, Ermel A, Tu W, Shew M, Brown DR. Association of HPV types 6, 11, 16, and 18 DNA detection and serological response in unvaccinated adolescent women. J Med Virol 2013; 85:1786-93. [PMID: 23861239 PMCID: PMC4874647 DOI: 10.1002/jmv.23664] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/11/2022]
Abstract
Antibodies directed against the human papillomavirus (HPV) L1 protein are detected in approximately 70% of individuals with HPV infections. The factors associated with a serological response are not characterized. It is hypothesized that the HPV viral load, duration of detection, or both would be associated with seropositivity in adolescent women. Adolescent women (n = 117), ages 15-17 at enrolment were followed for a mean of 6.2 years. Quarterly vaginal swabs (mean 22 per participant) were used to identify HPV 6, 11, 16, or 18 DNA (Roche PCR/Linear Array). Type-specific HPV infection was defined as ≥2 positive assays. To approximate viral load, Roche PCR/Linear Array test strips were scored visually based on the strength of signal relative to beta-globin controls. Sera collected near the end of study were tested by cLIA. Regression models were fit to assess associations between strength of signal (as represented by mean and cumulative strength of signal), duration of HPV detection, seropositivity, and serotiter. Detection of HPV DNA was associated with seropositivity for four types combined and for types 6, 16, and 18. Overall, 70.1% of DNA positive episodes were associated with type-specific seropositivity. The cumulative HPV DNA signal strength during periods of HPV detection for types 6, 11, 16, and 18 combined was associated with seropositivity (OR = 1.21, 95% CI 1.02-1.44 P = 0.026). No other HPV DNA predictors were found to be associated with seropositivity or serotiter.
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Affiliation(s)
- Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron Ermel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marcia Shew
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Darron R. Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana
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Konopnicki D, De Wit S, Clumeck N. HPV and HIV coinfection: a complex interaction resulting in epidemiological, clinical and therapeutic implications. Future Virol 2013. [DOI: 10.2217/fvl.13.69] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HPV and HIV each display interactions favoring the other infection at the cellular level. HPV infection favors HIV acquisition in women and men, and HIV-infected individuals encompass a heavier burden of HPV-induced dysplasia and cancer due to progressive immune suppression. Both infections contribute to a vicious circle that may account for the scale-up of both pandemics in some regions of the world. HAART might be beneficial in reducing HPV infection and associated lesions, but only after several years with optimal control of HIV viremia and an immune reconstitution of great amplitude. Yet, the incidence of cervical and anal cancer has not decreased in the HAART era. In this review, we will look at the viral interactions between HPV and HIV at the cellular and clinical levels. We will analyze the epidemiological link between the two epidemics and try to propose therapeutic and vaccine strategies to act on both pandemics.
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Affiliation(s)
- Deborah Konopnicki
- Infectious Diseases Department & AIDS Reference Center, Saint-Pierre University Hospital, Brussels, Belgium
| | - Stephane De Wit
- Infectious Diseases Department & AIDS Reference Center, Saint-Pierre University Hospital, Brussels, Belgium
| | - Nathan Clumeck
- Infectious Diseases Department & AIDS Reference Center, Saint-Pierre University Hospital, Brussels, Belgium
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Shew ML, Ermel AC, Weaver BA, Tong Y, Tu W, Kester LM, Denski C, Fortenberry JD, Brown DR. Association of Chlamydia trachomatis infection with redetection of human papillomavirus after apparent clearance. J Infect Dis 2013; 208:1416-21. [PMID: 23911713 DOI: 10.1093/infdis/jit346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Persistent infection with oncogenic human papillomavirus (HPV) is associated with an increased risk of cervical malignancy. Redetection of type-specific HPV after a period of nondetection may be caused by reactivation of a low-level persistent infection. Little is known about factors associated with type-specific HPV redetection. METHODS For a longitudinal cohort of adolescent women with frequent behavioral and sexually transmitted infection (STI) information (every 3 months), Cox proportional hazard models were used to assess the influence of sexual behaviors and STIs on the redetection of oncogenic or high-risk HPV infections. RESULTS A total of 210 type-specific high-risk HPV detection episode periods were identified in this longitudinal cohort; 71 (33.8%) were characterized by a period of nondetection followed by redetection. Chlamydia trachomatis (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.44-6.86) was associated with redetection; redetection was >2 times more likely with each additional self-reported sex partner in the past 3 months (HR, 2.26; 95% CI, 1.35-3.78). CONCLUSIONS This study demonstrates the role of C. trachomatis and number of recent sexual partners in type-specific HPV redetection. Given that persistent oncogenic HPV infections are associated with cancer-related outcomes, understanding the potential role of such factors in the pathogenesis of HPV-related outcomes is important.
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Evaluation of HIV and Highly Active Antiretroviral Therapy on the Natural History of Human Papillomavirus Infection and Cervical Cytopathologic Findings in HIV-Positive and High-Risk HIV-Negative Women. J Infect Dis 2013; 208:454-62. [DOI: 10.1093/infdis/jit181] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Konopnicki D, Manigart Y, Gilles C, Barlow P, de Marchin J, Feoli F, Larsimont D, Delforge M, De Wit S, Clumeck N. Sustained viral suppression and higher CD4+ T-cell count reduces the risk of persistent cervical high-risk human papillomavirus infection in HIV-positive women. J Infect Dis 2013; 207:1723-9. [PMID: 23463709 DOI: 10.1093/infdis/jit090] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Studies analyzing the impact of combination antiretroviral therapy (cART) on cervical infection with high-risk human papillomavirus (HR-HPV) have generated conflicting results. We assessed the long-term impact of cART on persistent cervical HR-HPV infection in a very large cohort of 652 women who underwent follow-up of HIV infection for a median duration of 104 months. METHODS Prospective cohort of HIV-infected women undergoing HIV infection follow-up who had HR-HPV screening and cytology by Papanicolaou smear performed yearly between 2002 and 2011. RESULTS At baseline, the median age was 38 years, the race/ethnic origin was sub-Sarahan Africa for 84%, the median CD4(+) T-cell count was 426 cells/µL, 79% were receiving cART, and the HR-HPV prevalence was 43%. The median interval of having had an HIV load of <50 copies/mL was 40.6 months at the time of a HR-HPV-negative test result, compared with 17 months at the time of a HR-HPV-positive test result (P < .0001, by univariate analysis). The median interval of having had a CD4(+) T-cell count of >500 cells/µL was 18.4 months at the time of a HR-HPV-negative test result, compared with 4.45 months at the time of a HR-HPV-positive test result (P < .0001). In multivariate analysis, having had an HIV load of <50 copies/mL for >40 months (odds ratio [OR], 0.81; 95% confidence interval [CI], .76-.86; P < .0001) and having had a CD4(+) T-cell count of >500 cells/µL for >18 months (OR, 0.88; 95% CI, .82-.94; P = .0002) were associated with a significantly decreased risk of HR-HPV infection. CONCLUSION Sustained HIV suppression for >40 months and a sustained CD4(+) T-cell count of >500 cells/µL for >18 months are independently and significantly associated with a decreased risk of persistent cervical HR-HPV infection.
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Affiliation(s)
- Deborah Konopnicki
- Department of Infectious Diseases and AIDS Reference Center, Saint-Pierre University Hospital, rue Haute 322, Brussels 1000, Belgium.
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Jensen SE, Pereira DB, Whitehead N, Buscher I, McCalla J, Andrasik M, Rose R, Antoni MH. Cognitive-behavioral stress management and psychological well-being in HIV+ racial/ethnic minority women with human papillomavirus. Health Psychol 2013; 32:227-230. [PMID: 22545977 PMCID: PMC3670138 DOI: 10.1037/a0028160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study is a secondary analysis examining the effects of a cognitive-behavioral stress management (CBSM) intervention on indicators of positive psychological well-being and negative psychological well-being in HIV-positive racial/ethnic minority women at risk for cervical cancer due to human papillomavirus (HPV) infection and/or cervical intraepithelial lesions (CIN). METHOD Racial/ethnic minority women with HIV and HPV and/or CIN I were randomized to a 10-week CBSM group or a 1-day psychoeducational seminar. Participants completed a battery of measures of positive and negative psychological well-being at 3 time points: preintervention, 3 months postenrollment, and 9 months postenrollment. RESULTS Women in the CBSM group reported significant increases in domains of positive well-being, with no changes among women in the psychoeducational seminar, F(6, 63) = 2.42, p < .05, η² = .19. There were no significant changes in domains of negative well-being across time for either group, F(2, 65) = 2.60, p = .08, η² = .07. CONCLUSION These findings suggest that racial/ethnic minority women with HIV at risk for cervical cancer who were randomized to a 10-week CBSM group experienced enhanced positive well-being. The lack of effects on negative well-being may be due to the relatively low levels of negative well-being present in this sample at study entry. Future research should examine whether these effects are replicated in a randomized controlled trial of women with biopsy-confirmed CIN who present with greater distress levels that also employs a time-equivalent comparison condition.
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Affiliation(s)
- Sally E Jensen
- Department of Medical Social Sciences and Department of Surgery, Northwestern University Feinberg School of Medicine
| | - Deidre B Pereira
- Department of Clinical and Health Psychology, University of Florida
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Rositch AF, Gravitt PE, Tobian AAR, Newell K, Quinn TC, Serwadda D, Ssebbowa P, Kiggundu V, Gray RH, Reynolds SJ. Frequent detection of HPV before and after initiation of antiretroviral therapy among HIV/HSV-2 co-infected women in Uganda. PLoS One 2013; 8:e55383. [PMID: 23383171 PMCID: PMC3558485 DOI: 10.1371/journal.pone.0055383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Most data on HPV and antiretroviral therapy (ART) come from high-resource countries with infrequent sampling for HPV pre- and post-ART initiation. Therefore, we examined the frequency of cervical HPV DNA detection among HIV/HSV-2 co-infected women followed monthly for 6 months both before and after initiation of ART in Rakai, Uganda. METHODS Linear Array was used to detect 37 HPV genotypes in self-collected cervicovaginal swabs from 96 women who initiated ART. Random-effects log-binomial regression was used to compare the prevalence of HPV detection in the pre- and post-ART periods and determine other potential risk factors, including CD4 counts and HIV viral load. RESULTS Nearly all women had detectable HPV in the 6 months preceding ART initiation (92%) and the cumulative prevalence remained high following initiation of therapy (90%). We found no effect of ART on monthly HPV DNA detection (prevalence ratio: 1.0; 95% confidence interval: 0.96, 1.08), regardless of immune reconstitution or HIV viral suppression. Older age and higher pre-ART CD4 counts were associated with a significantly lower risk of HPV DNA detection. CONCLUSIONS ART did not impact HPV detection within 6 months of therapy initiation, highlighting the importance of continued and consistent screening, even after ART-initiation and immune reconstitution.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
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Prevalence and risk factors for HPV in HIV-positive young women receiving their first HPV vaccination. J Acquir Immune Defic Syndr 2013; 61:390-9. [PMID: 22820809 DOI: 10.1097/qai.0b013e3182676fe3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The objectives of this study were to describe the prevalence and risk factors for HPV infection among HIV-infected young women receiving their first quadrivalent HPV (HPV-6, -11, -16, and -18) vaccine dose. METHODS We recruited 16- to 23-year-old women from 14 sites for an HPV vaccine trial. At the first visit, they completed a questionnaire and were tested for cervicovaginal HPV DNA (41 types) and HPV serology (4 vaccine types). Factors associated with any HPV, type-specific HPV, and high-risk (cancer-associated) HPV infections were identified using univariate and multivariable logistic regression. RESULTS The mean age of participants (N = 99) was 21.4 years, 30.3% were on antiretroviral therapy, 74.7% were positive for ≥1 HPV DNA type, 53.5% for ≥1 high-risk type, 12.1% for HPV-16, and 5.1% for HPV-18. Most were HPV DNA negative and seronegative for HPV-16 (55.6%) and HPV-18 (73.7%); 45.5% were HPV DNA negative and seronegative for both HPV-16 and -18. Three variables were associated with high-risk HPV DNA in multivariable analysis: non-Hispanic black versus Hispanic ethnicity (adjusted odds ratio [AOR]: 7.06, 95% CI: 1.63 to 30.5), HIV viral load ≥ 400 versus <400 copies/mL (AOR: 3.47, 95% CI: 1.28 to 9.43), and frequency of vaginal sex in the past 90 days (AOR: 5.82, 95% CI: 1.30 to 26.11 for ≥6 vs 0 times). CONCLUSIONS The prevalence of ≥1 HPV type was high in these young women, demonstrating the importance of vaccinating before sexual initiation. However, most women were HPV DNA negative and seronegative for high-risk vaccine-type HPV infection, supporting vaccination of sexually experienced HIV-positive young women.
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Abstract
Investigating the prevalence of high-risk human papilloma virus (HPV) genotypes in human immunodeficiency virus (HIV)-infected women is vital to generate data for formulating guidelines for prevention/screening of cervical cancer in this vulnerable group. The study was aimed to analyze the HPV genotypes in HIV-infected women. It was a prospective, hospital-based, and cross-sectional study. HIV-infected women were enrolled from the antiretroviral clinic and controls from the gynecology outpatient. The HPV genotyping array kit was used for identifying 21 HPV genotypes. Detection of HPV was confirmed by performing an HPV type-specific polymerase chain reaction. A Pap smear was collected in all women. One hundred thirty HIV-infected women and 64 controls were enrolled. All women with low CD4 counts (n=97) were receiving antiretroviral therapy. Twenty-six (20%) HIV-infected women and 12 (18.7%) women in the control group tested positive for high-risk HPV (P=1.0). HPV 16 was the most common type, detected in 42% of HPV-positive women in the HIV-infected cohort, followed by HPV 45 (15%), HPV 18/52/31/58 (11.5% each), and HPV 33 (7.6%). The corresponding figures in the control group were as follows: HPV 16 (66.6%), HPV 45/18/31 (16.6% each), and HPV 33/58/68 (8.3% each). Cervical intraepithelial neoplasia was detected in 2.3% of HIV-infected women. The prevalence of high-risk HPV in HIV-infected women (20%) was similar to the prevalence in controls (18.7%). This and the incidence of cervical intraepithelial neoplasia are lower than those in previous reports. It is plausible that administration of antiretroviral therapy contributed to the reduced prevalence. The currently available vaccine would likely be beneficial to the local HIV-infected population, as nearly half the HPV-infected women harbored genotypes 16 or 18.
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Use of highly active antiretroviral therapy is associated with lower prevalence of anal intraepithelial neoplastic lesions and lower prevalence of human papillomavirus in HIV-infected men who have sex with men. Sex Transm Dis 2012; 39:495-500. [PMID: 22695316 DOI: 10.1097/olq.0b013e31825aa764] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of anal intraepithelial neoplasia (AIN) and anal cancer is increased in HIV-positive men who have sex with men (MSM). Persistent high-risk human papillomavirus (HPV) infection is an important etiologic agent. METHODS In this study, a group of 250 HIV-positive MSM was included to determine the prevalence of AIN and to investigate the role of highly active antiretroviral therapy (HAART), high-risk HPV, and other risk factors possibly associated with this prevalence. RESULTS Among patients included, 108 (43.2%) had lesions suspicious for AIN. Histologic analyses showed AIN 1 in 24 patients (22.2%), AIN 2 in 6 patients (5.6%), and AIN 3 in 10 patients (9.3%). In multivariable analyses, the use of HAART was associated with the absence of AIN (P = 0.045). In MSM without HAART, HPV infection was detected significantly more often compared with those who used HAART (P = 0.010). AIN was associated with HPV types 16 and 6. CONCLUSIONS In this cross-sectional study in 250 HIV-positive MSM, the use of HAART was associated with lower prevalence of AIN and a significantly lower prevalence of HPV. This association between the prevalence of AIN and the absence of HAART may contribute to the current debate on when to start HAART in HIV-infected individuals.
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Cummings T, Zimet GD, Brown D, Tu W, Yang Z, Fortenberry JD, Shew ML. Reduction of HPV infections through vaccination among at-risk urban adolescents. Vaccine 2012; 30:5496-9. [PMID: 22750043 DOI: 10.1016/j.vaccine.2012.06.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/14/2012] [Accepted: 06/18/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccine trials have demonstrated high efficacy in preventing HPV infections and HPV related disease in females ages 16-26. However, there is no source data to demonstrate the impact of the vaccine in other populations who may be at higher risk for HPV related disease. This study examines the impact of HPV vaccination on subsequent HPV detection and sexual behaviors among urban adolescents in a clinical setting. METHODS A cohort of adolescent women, ages 14-17, were recruited prospectively and matched to historical controls to assess the impact of HPV vaccination. All women completed the same questionnaire and face-to-face interview that assessed sexual behaviors; all provided a clinician or self-collected vaginal swab that was used to test for sexually transmitted infections, including HPV. Logistic regression models, incorporating random pair effects, were used to assess the impact of the HPV vaccine on HPV detection and sexual behaviors between the two groups. RESULTS Each woman recruited (N=75) was matched to 2 historical controls (HC); most of the recruited women (89.3%) had received one or more doses of the HPV vaccine. At enrollment, detection of quadrivalent vaccine types (HPV 6, 11, 16 and 18) was significantly less in the recruited group (5.3%) as compared to the HC (24%): OR=5.6 (CI=1.9, 16.5), p=0.002. Adolescent women in the HC had a 9.5 times greater odds of HPV infection when the analysis was adjusted to compare those who had 2 or more vaccine doses to their matched controls. The only behavioral difference found was that the recruited women used condoms more frequently. CONCLUSION This study demonstrates that HPV vaccination was associated with fewer vaccine-type HPV infections despite incomplete vaccination and high risk sexual behaviors. These data also suggest that sexual behaviors were not altered because of the vaccine.
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Affiliation(s)
- Teresa Cummings
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
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Kang M, Cu-Uvin S. Association of HIV viral load and CD4 cell count with human papillomavirus detection and clearance in HIV-infected women initiating highly active antiretroviral therapy. HIV Med 2012; 13:372-8. [PMID: 22257000 DOI: 10.1111/j.1468-1293.2011.00979.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2011] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The extent to which highly active antiretroviral therapy (HAART) affects human papillomavirus (HPV) acquisition and clearance in HIV-infected women is not well understood. We sought to describe high-risk HPV detection and clearance rates over time since HAART initiation, based on time-varying HIV viral load (VL) and CD4 T-cell count, using novel statistical methods. METHODS We conducted a retrospective analysis of data from the completed AIDS Clinical Trials Group (ACTG) A5029 study using multi-state Markov models. Two sets of high-risk HPV types from 2003 and 2009 publications were considered. RESULTS There was some evidence that VL>400 HIV-1 RNA copies/mL was marginally associated with a higher rate of HPV detection [P=0.068; hazard ratio (HR) =4.67], using the older set of high-risk HPV types. Such an association was not identified using the latest set of HPV types (P=0.343; HR=2.64). CD4 count >350 cells/μL was significantly associated with more rapid HPV clearance with both sets of HPV types (P=0.001, HR=3.93; P=0.018, HR=2.65). There was no evidence that HPV affects VL or CD4 cell count in any of the analyses. CONCLUSIONS High-risk HPV types vary among studies and can affect the results of analyses. Use of HAART to improve CD4 cell count may have an impact on the control of HPV infection. The decrease in VL may also have an effect, although to a lesser degree.
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Affiliation(s)
- M Kang
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115, USA.
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Luu HN, Amirian ES, Chan W, Beasley RP, Piller LB, Scheurer ME. CD4+ cell count and HIV load as predictors of size of anal warts over time in HIV-infected women. J Infect Dis 2012; 205:578-85. [PMID: 22246682 DOI: 10.1093/infdis/jir813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the associations between CD4(+) cell counts, human immunodeficiency virus (HIV) load, and human papillomavirus "low-risk" types in noncancerous clinical outcomes. This study examined whether CD4(+) count and HIV load predict the size of the largest anal warts in 976 HIV-infected women in an ongoing cohort. METHODS A linear mixed model was used to determine the association between size of anal wart and CD4(+) count and HIV load. RESULTS The incidence of anal warts was 4.15 cases per 100 person-years (95% confidence interval [CI], 3.83-4.77) and 1.30 cases per 100 person-years (95% CI, 1.00-1.58) in HIV-infected and HIV-uninfected women, respectively. There appeared to be an inverse association between size of the largest anal warts and CD4(+) count at baseline; however, this was not statistically significant. There was no association between size of the largest anal warts and CD4(+) count or HIV load over time. CONCLUSIONS There was no evidence for an association between size of the largest anal warts and CD4(+) count or HIV load over time. Further exploration on the role of immune response on the development of anal warts is warranted in a larger study.
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Affiliation(s)
- Hung N Luu
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Weaver B, Shew M, Qadadri B, Tu W, Tong Y, Denski C, Fortenberry JD, Ermel A, Brown D. Low-level persistence of human papillomavirus 16 DNA in a cohort of closely followed adolescent women. J Med Virol 2011; 83:1362-9. [PMID: 21678439 DOI: 10.1002/jmv.22116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most human papillomavirus (HPV) infections in young women become undetectable by standard assays after a few months. It is possible that many HPV infections do not actually clear, but persist at very low levels for years, becoming detected again later in life. The purpose of this study is to describe HPV 16 clearance, reappearance, and low-level persistence in a cohort of adolescent women. Adolescent women (N = 66), not vaccinated against HPV, were recruited from 1998 to 2008 into a longitudinal study. Self-collected vaginal samples were obtained quarterly and tested for HPV by Linear Array HPV Genotyping Test (LA-HPV). To explore low-level persistence, a type-specific nested PCR for HPV 16 (TSN-PCR-16) was developed. Women with HPV 16 detected by LA-HPV had their negative swabs retested with TSN-PCR-16. Forty-two participants with HPV 16, followed for a mean of 6.3 years, were analyzed. Using LA-HPV, the median duration of HPV 16 detection was 428 days (SD 852.5 days). TSN-PCR-16 detected HPV 16 during periods of LA-HPV non-detection in samples from many women. Using a combination of LA-HPV and TSN-PCR-16 results, the median duration of HPV 16 detection was 1,022.5 days (SD 943.7 days). The durations of detection differed significantly between the two methods (P = 0.0042) with a mean difference of 434.5 days. In adolescent females, duration of HPV 16 detection was significantly longer when TSN-PCR-16 was combined with LA-HPV. Some apparently cleared HPV 16 could be shown to persist at low levels using nested PCR.
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Affiliation(s)
- B Weaver
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Adler DH. The impact of HAART on HPV-related cervical disease. Curr HIV Res 2011; 8:493-7. [PMID: 20946095 DOI: 10.2174/157016210793499240] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 10/24/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW highly active antiretroviral therapy (HAART) has had an unequivocally positive impact on morbidity and mortality in HIV-infected individuals. These benefits have clearly extended to some HIV-related malignancies, including Kaposi's sarcoma and non-Hodgkin's lymphoma. The impact of HAART on cervical cancer, however, remains uncertain. The objective of this review is to summarize the last ten years of registry-based and clinical research into the impact of HAART on human papillomavirus (HPV) related cervical disease. RELEVANT FINDINGS compared to their HIV-uninfected counterparts, HIV-infected women have an increased prevalence of HPV infection, increased risk of progression of HPV-related cervical disease, and an increased risk of invasive cervical cancer. While the partial immune reconstitution afforded by HAART might be expected to decrease susceptibility to HPV infection and cervical disease, the local effects of improved immunosurveillance on the cervix are uncertain and the increased longevity of patients on HAART may increase risk of exposure to HPV and provide the time required for progression of cervical disease. Registry-based evidence has been consistent in identifying the lack of decrease in cervical cancer incidence in the HAART era. Clinical research on the subject, however, has produced conflicting evidence with regards to both the effect of HAART on HPV infection and its impact on cervical disease progression/regression. SUMMARY the incidence of cervical cancer has not decreased in the HAART-era. Furthermore, clinical research has not shown a clear benefit of HAART in decreasing HPV-related cervical disease in HIV-infected women. A better understanding of this subject will have an impact on cervical disease surveillance practices.
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Affiliation(s)
- David H Adler
- University of Rochester, 601 Elmwood Avenue, Box 655, Rochester, NY 14642, USA.
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Weaver B, Shew M, Qadadri B, Tu W, Tong Y, Denski C, Fortenberry JD, Brown D. Natural history of multiple human papillomavirus infections in female adolescents with prolonged follow-up. J Adolesc Health 2011; 48:473-80. [PMID: 21501806 DOI: 10.1016/j.jadohealth.2010.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/04/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to better characterize the natural history of human papillomavirus (HPV) infections in female adolescents. METHODS Female adolescents were enrolled in a longitudinal study. Self-vaginal samples were obtained every 3 months and tested for HPV. No participants received HPV vaccination. The findings for 40 female adolescents with the longest follow-up are reported in this study. RESULTS Average age at the time of enrollment was 15.2 years (range: 14-17; SD: .97). Mean duration of follow-up was 6.7 years (range: 4.4-9.2; SD: 1.2). In all, 32 participants (80%) reported being involved in sexual activity before their enrollment in the study; all reported being involved in sexual activity before enrollment; all reported being involved in sexual activity during follow-up. Baseline and cumulative prevalence of HPV among participants was 55% and 100%, respectively. During the study, each participant tested positive for a mean of 14 HPV types. Cumulatively, HPV 16 was detected in 29 of 40 participants (72.5%). Mean duration of high- and low-risk infections was 655.9 (median: 433) and 524.1 days (median: 334), respectively. CONCLUSION With prolonged follow-up, HPV infections with multiple types were found in all participants. Most had infection with HPV-16 or HPV-18, the oncogenic types represented in current vaccines, as well as infection with other oncogenic types. These data reinforce the importance of vaccine and non-vaccine strategies for prevention of HPV infections.
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Affiliation(s)
- Bree Weaver
- Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA
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Veldhuijzen NJ, Snijders PJ, Reiss P, Meijer CJ, van de Wijgert JH. Factors affecting transmission of mucosal human papillomavirus. THE LANCET. INFECTIOUS DISEASES 2010; 10:862-74. [PMID: 21075056 DOI: 10.1016/s1473-3099(10)70190-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection. The effect of HPV on public health is especially related to the burden of anogenital cancers, most notably cervical cancer. Determinants of exposure to HPV are similar to those for most sexually transmitted infections, but determinants of susceptibility and infectivity are much less well established. Gaps exist in understanding of interactions between HPV, HIV, and other sexually transmitted infections. The roles of mucosal immunology, human microbiota at mucosal surfaces, host genetic factors and hormonal concentrations on HPV susceptibility and infectivity are poorly understood, as are the level of effectiveness of some primary or secondary preventive measures other than HPV vaccination (such as condoms, male circumcision, and combination antiretroviral therapy for HIV). Prospective couples studies, studies focusing on mucosal immunology, and in-vitro raft culture studies mimicking HPV infection might increase understanding of the dynamics of HPV transmission.
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Affiliation(s)
- Nienke J Veldhuijzen
- Academic Medical Center of the University of Amsterdam, Department of Internal Medicine, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
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41
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Ermel A, Qadadri B, Morishita A, Miyagawa I, Yamazaki G, Weaver B, Tu W, Tong Y, Randolph M, Cramer H, Brown D. Human papillomavirus detection and typing in thin prep cervical cytologic specimens comparing the Digene Hybrid Capture II Assay, the Roche Linear Array HPV Genotyping Assay, and the Kurabo GeneSquare Microarray Assay. J Virol Methods 2010; 169:154-61. [PMID: 20670658 DOI: 10.1016/j.jviromet.2010.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 07/13/2010] [Accepted: 07/20/2010] [Indexed: 11/30/2022]
Abstract
Three methods for the detection of HPV DNA were compared in cervical cytologic specimens: the Digene Hybrid Capture II Assay (HC), the Roche Linear Array HPV Genotyping Assay (LA) and the Kurabo GeneSquare Microarray (GS). The main goals of the study were to correlate cytology with HPV detection and to determine agreement between assay pairs for HPV detection. Thin-prep Pap smears were performed and supernates were tested by HC, LA, and GS. For specimens reacting with the HPV 52/33/35/58 probe in the LA assay, type-specific PCR was performed for HPV types 52, 33, 35, or 58. Binomial proportions and kappa coefficients were calculated for agreement between assays. Cytology results and supernatant were available for 202 subjects. HPV detection increased with worsening cytologic abnormality in all three assays. For all cytologic groups, LA and GS detected more HPV (all and oncogenic) than HC. However, for detection of oncogenic HPV types represented in all three assays, differences between assays were less pronounced. The highest agreement was between LA and GS. In four of 12 specimens reacting with the HPV 52/33/35/58 probe in the LA assay but deemed HPV 52-LA-negative using an algorithm provided by the manufacturer, the presence of HPV 52 was confirmed using type-specific HPV 52 PCR. All four of these specimens were also GS-positive for HPV 52.
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Affiliation(s)
- A Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
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42
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Bratcher LF, Sahasrabuddhe VV. The impact of antiretroviral therapy on HPV and cervical intraepithelial neoplasia: current evidence and directions for future research. Infect Agent Cancer 2010; 5:8. [PMID: 20462441 PMCID: PMC2881893 DOI: 10.1186/1750-9378-5-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 05/12/2010] [Indexed: 01/29/2023] Open
Abstract
Increasing numbers of human immunodeficiency virus (HIV)-infected women are now accessing life-prolonging highly active antiretroviral therapy (HAART) in developing countries. There is a need for better understanding of interactions of human papillomavirus (HPV) and HIV, especially in the context of increasing life expectancy due to HAART. The data regarding the impact of HAART on reducing the incidence and progression and facilitating the regression of HPV infection and cervical abnormalities is largely inconsistent. Published studies differ in their study designs (prospective or retrospective cohorts or record linkage studies), screening and diagnostic protocols, duration and type of HAART use, recruitment and referral strategies, and definitions of screening test and disease positivity. Due to the ethical and resource limitations in conducting randomized trials of the impact of HAART on incidence of HPV, CIN, and cervical cancer among HIV-infected women, it is important to consider innovative study designs, including quasi-experimental trials and operations research in sentinel populations to answer the critical research questions in this area.
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Affiliation(s)
- Lara F Bratcher
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, USA
| | - Vikrant V Sahasrabuddhe
- Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, USA
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43
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Strickler HD. Does HIV/AIDS have a biological impact on the risk of human papillomavirus-related cancers? J Natl Cancer Inst 2009; 101:1103-5. [PMID: 19648509 DOI: 10.1093/jnci/djp236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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