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D’Souza G, Tewari SR, Troy T, Webster-Cyriaque J, Wiley DJ, Lahiri CD, Palella FJ, Gillison ML, Strickler HD, Struijk L, Waterboer T, Ho K, Kwait J, Lazar J, Weber KM, Fakhry C. Oncogenic Oral Human Papillomavirus Clearance Patterns over 10 Years. Cancer Epidemiol Biomarkers Prev 2024; 33:516-524. [PMID: 38294704 PMCID: PMC10990780 DOI: 10.1158/1055-9965.epi-23-1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Effective screening for oropharyngeal cancer is lacking. Four oncogenic HPV clearance definitions were explored to understand long-term natural history for persistent oncogenic oral HPV (oncHPV), the precursor of oropharyngeal cancer. METHODS Prospective multicenter cohort of participants living with/at-risk for HIV, with oral rinse and gargle samples collected every 6 to 12 months for up to 10 years and tested for oncHPV. HPV clearance definitions included 1 (clear1), 2 (clear2), 3 (clear3) consecutive negatives, or being negative at last two visits (clearlast). RESULTS Median time to clearance of oncHPV exceeded 2 years for conservative definitions (clear3: 2.38, clearlast: 2.43), but not lenient (clear1: 0.68, clear2: 1.15). By clear3, most incident infections cleared at 2, 5, 8 years (55.1%, 75.6%, 79.1%), contrary to prevalent infections (37.1%, 52.5%, 59.5%, respectively). In adjusted analysis, prevalent oncHPV, older age, male sex, and living with HIV were associated with reduced clearance. Of 1,833 subjects screened, 13.8% had prevalent oncHPV and 47.5% of those infections persisted ≥5 years, representing 6.5% of persons screened. Two men with prevalent oral HPV16 developed incident oropharyngeal cancer [IR = 1.62 per 100 person-years; 95% confidence interval (CI), 0.41-6.4]. Many with oral HPV16 persisted ≥5 years (and/or developed HPV-oropharyngeal cancer) among those with 2 (72.2%), ≥2 of first 3 (65.7%), or 3 (80.0%) consecutive positive oHPV16 tests, but not after 1 (39.4%). CONCLUSIONS In our 10-year study, most incident infections cleared quickly. However, half of prevalent oncHPV persisted ≥5 years, suggesting increased risk with persistent oncHPV at >2 visits. IMPACT We identified groups with persistent oncHPV at increased risk of oropharyngeal cancer and contextualized risk levels for those with oral HPV16 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Sakshi R. Tewari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | | | - Dorothy J. Wiley
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Cecile Delille Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura L. Gillison
- Department of Thoracic-Head and neck medical oncology, MD Anderson Cancer Center
| | - Howard D. Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Linda Struijk
- Viroclinics-DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Jason Lazar
- Department of Medical Education, SUNY Downstate Health Science University
| | | | - Carole Fakhry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
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Gupta R, Hussain S, Hariprasad R, Dhanasekaran K, Verma S, Agarwal V, Sandeep, Parveen S, Kaur A, Verma CP, Amita, Dwivedi R, Singh S, Gupta S. High Prevalence of Cervical High-Grade Lesions and High-Risk Human Papillomavirus Infections in Women Living with HIV: A Case for Prioritizing Cervical Screening in This Vulnerable Group. Acta Cytol 2022; 66:496-506. [PMID: 35760059 DOI: 10.1159/000525340] [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: 01/09/2022] [Accepted: 05/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors. METHODS A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs. RESULTS The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03). CONCLUSION Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Showket Hussain
- Molecular Biology Group, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sheel Verma
- Medical Officer and Incharge, ART Centre, District Hospital (MMG Hospital), Ghaziabad, India
| | - Vineeta Agarwal
- Department of Gynecology and Obstetrics, Dr Bhim Rao Ambedkar Multispecialty Hospital, Noida, India
| | - Sandeep
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Shahana Parveen
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | | | - Chandresh Pragya Verma
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Amita
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Reena Dwivedi
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sompal Singh
- Department of Pathology, Hindu Rao Hospital, Delhi, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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3
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Njagi SK, Ngure K, Mwaniki L, Kiptoo M, Mugo NR. Prevalence and correlates of cervical squamous intraepithelial lesions among HIV-infected and uninfected women in Central Kenya. Pan Afr Med J 2021; 39:44. [PMID: 34422167 PMCID: PMC8356940 DOI: 10.11604/pamj.2021.39.44.27182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/27/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction cervical intraepithelial neoplasia the precursor of cervical cancer occurs with increased frequency in women infected with human immunodeficiency virus (HIV). This study aimed at determining the prevalence and correlates of abnormal cervical cytology among HIV-infected women and compare to the uninfected women. Methods a cross-sectional study conducted among HIV-infected and uninfected women enrolled in a HIV study in Central Kenya. All women had baseline Pap smear examination assessed using Bethesda system. Bivariate and multivariate logistic regression methods were employed to assess the correlates of cervical squamous epithelial lesions (CSIL). Results a total 480 women had an acceptable baseline smear, 373 (78%) were HIV-infected. Median age was 30.2 years [IQR 25.4-35.5]. Overall prevalence of CSIL was 37% (176/480) with the prevalence of low grade squamous intraepithelial lesion (LSIL), atypical squamous cells undetermined significance (ASCUS), high grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC) were 17%, 14%, 4% and 2% respectively. HIV-infected women had a higher prevalence of CSIL at 42% as compared to HIV-uninfected women at 19%. HIV infection was the predictor associated with development of CSIL at multivariate analysis and specifically, HIV-infected women were 3 times (AOR 3.1, 95% CI: 1.8 - 5.4, p<0.005) more likely to have CSIL than HIV-uninfected women. The age 35 - 44 years was protective to developing CSIL (AOR 0.45, 95% CI: 0.24 - 0.87, p=0.018). Conclusion cervical squamous epithelial lesions is a major problem among Kenyan women. HIV infection confers a higher risk to development of CSIL. Cervical cancer screening should be an established practice in HIV programs.
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Affiliation(s)
- Stella Kawira Njagi
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya.,Partners in Health, Research and Development, Thika Section 9, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Lawrence Mwaniki
- Partners in Health, Research and Development, Thika Section 9, Nairobi, Kenya
| | - Michael Kiptoo
- Institute for Tropical Medicine and HIV and AIDS Laboratory, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Rwamba Mugo
- Sexual Reproduction and Adolescent Child Health Research Program, Kenya Medical Research Institute, Nairobi, Kenya
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Luckett R, Painter H, Hacker MR, Simon B, Seiphetlheng A, Erlinger A, Eakin C, Moyo S, Kyokunda LT, Esselen K, Feldman S, Morroni C, Ramogola-Masire D. Persistence and clearance of high-risk human papillomavirus and cervical dysplasia at 1 year in women living with human immunodeficiency virus: a prospective cohort study. BJOG 2021; 128:1986-1996. [PMID: 34008294 DOI: 10.1111/1471-0528.16758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV). DESIGN Prospective cohort study. SETTING HIV treatment centre in Botswana. POPULATION Women living with HIV. METHODS Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard. MAIN OUTCOME MEASURES Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia. RESULTS Among 300 women screened at baseline, 237 attended follow up (79%). High-risk HPV positivity significantly decreased from 28% at baseline to 20% at 1 year (P = 0.02). High-risk HPV persistence was 46% and clearance was 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). Of the high-risk HPV-positive participants at baseline with <CIN2, 40% progressed to CIN2 or higher at follow up. CONCLUSION The high incidence of high-risk HPV and high-grade cervical dysplasia in women living with HIV after one round of high-risk HPV-based screening and treatment raises concern about the rate of progression of high-risk HPV infection to dysplasia. Persistent disease is common. Caution in spacing cervical cancer screening intervals using high-risk HPV testing in women living with HIV is warranted. TWEETABLE ABSTRACT High incidence and persistence of HPV and CIN2+ in women living with HIV 1 year after screening and treatment.
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Affiliation(s)
- R Luckett
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - H Painter
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - M R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - B Simon
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - A Seiphetlheng
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - A Erlinger
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C Eakin
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Creighton University School of Medicine-Phoenix, Phoenix, AZ, USA
| | - S Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - L T Kyokunda
- Department of Pathology, University of Botswana, Gaborone, Botswana
| | - K Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Feldman
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - C Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Ramogola-Masire
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
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Yadav A, Baveja P, Singh S. Spectrum of cervical epithelial abnormalities in immune surveillance patients and its association with CD4 count. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aina IO, Raul SM, Padilla LA, Mthethwa-Hleta S, Preko PO, Jolly PE. Sociodemographic factors, health seeking behaviors, reproductive history, and knowledge of cervical screening among women in Swaziland. Infect Agent Cancer 2020; 15:16. [PMID: 32165914 PMCID: PMC7059331 DOI: 10.1186/s13027-020-00282-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer among women in Swaziland; however, a low rate of cervical screening in this population has led to high rates of morbidity and mortality from cervical cancer. OBJECTIVE To identify factors associated with lack of cervical screening among women in Swaziland. METHODS A cross-sectional study was conducted among 300 women aged 18-69 years attending clinics in three regions of Swaziland from May to August of 2014. An investigator-administered questionnaire was used to collect data on socioeconomic factors, health-seeking behaviors, reproductive history, and cervical screening history and knowledge from the women. RESULTS Adjusted multivariable logistic regression analysis revealed that women < 30 years of age were less likely to receive a cervical exam compared to women ≥30 years of age (Odds Ratio 0.06, 95% Confidence Interval 0.01-0.67). Women who had a tertiary education were almost 6 times more likely to receive a cervical screening (OR 5.83, 95% CI 1.11-30.50). Women who said that they did not know when to receive cervical screening were 73% less likely to have a cervical exam (OR 0.27, 95% CI 0.01-0.74). CONCLUSIONS Younger age, lower educational level, and lack of knowledge about when to receive a cervical screening affected whether women obtained a cervical screening. This indicates the need for educating women, particularly younger women, about the importance of cervical examinations. Addressing these barriers to screening should lead to a decrease in cervical lesions and cancer, especially in this high HIV-positive population.
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Affiliation(s)
- Ibironke O. Aina
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Boulevard, Birmingham, AL 35294-0022 USA
| | - Smruti M. Raul
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Boulevard, Birmingham, AL 35294-0022 USA
| | - Luz A. Padilla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Boulevard, Birmingham, AL 35294-0022 USA
| | - Simangele Mthethwa-Hleta
- Ministry of Health and Social Welfare, 2nd Floor Ministry of Justice & Constitutional Affairs Building, Mhalambanyatsi Road, Mbabane, Swaziland
| | - Peter O. Preko
- Care and Treatment Lead for the President’s Emergency Plan for AIDS Relief (PEPFAR), Jubela Street; Kent Rock, Mbabane, Swaziland
| | - Pauline E. Jolly
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Boulevard, Birmingham, AL 35294-0022 USA
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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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Gupta K, Philipose CS, Rai S, Ramapuram J, Kaur G, Kini H, Gv C, Adiga D. A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India. Acta Cytol 2019; 63:50-55. [PMID: 30721904 DOI: 10.1159/000496211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/12/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ2 test was used to analyze the data and a p value < 0.05 was considered to be significant. RESULTS Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34-49 years. CD4 cell counts fell in the range of 200-500 cells/mm3 in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. CONCLUSION Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200-500 cells/mm3.
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Affiliation(s)
- Kritika Gupta
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Cheryl Sarah Philipose
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India,
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - John Ramapuram
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Gagandeep Kaur
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Chaithra Gv
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Deepa Adiga
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
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9
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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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10
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Weldegebreal F, Worku T. Precancerous Cervical Lesion Among HIV-Positive Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Cancer Control 2019; 26:1073274819845872. [PMID: 31043067 PMCID: PMC6572896 DOI: 10.1177/1073274819845872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/03/2019] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
In sub-Saharan Africa, cervical cancer is an intersecting epidemic with HIV and it is the second most common cause of cancer-related deaths in women. Therefore, this study was aimed to estimate the current status of the prevalence and associated factors of precancerous cervical lesions among HIV-positive women in sub-Saharan Africa. A systematic literature search was conducted from legitimate electronic databases, including MEDLINE (Ovid), PubMed, EMBASE (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), Web of Science, Scopus, and PopLine and other gray literature including Google, Google Scholar, World Cat, ResearchGate, and Mednar. Data were extracted with a structured format prepared in Microsoft Excel. Each study was evaluated using the Joanna Briggs Institute critical appraisal tool for cross-sectional and cohort studies checklists. Accordingly, medium and high-quality studies were included in the review. Data synthesis and statistical analysis was conducted using OpenMeta and comprehensive meta-analysis version 2 software. The study protocol is registered on PROSPERO with ID: CRD42018114266. The pooled prevalence of precancerous cervical lesion among HIV-positive women in sub-Saharan Africa was 25.6% (95% confidence interval [CI]: 19.4%-31.8%). Having more than 2 lifetime sexual partners (odds ratio [OR]: 4.77; 95% CI: 1.35-16.93), having had a history of sexually transmitted infections (STIs; OR: 1.92; 95% CI: 1.03-3.57), having more than 2 births (OR: 1.84; 95% CI: 1.33-2.53), and CD4 count <200 cells/mm3 (OR: 1.765; 95% CI: 1.23-2.535) were significantly associated with precancerous cervical lesions. The prevalence of precancerous cervical lesion among HIV-positive women was high. One in 4 HIV-infected women suffers from precancerous cervical lesion. Lower CD4 cell count, STIs, multiple sexual partnering, and histories of multiple births and abortions were the foremost contributing factors for this burden. Precancerous cervical lesion could be reduced significantly if preventive and promotive measures are done on the associated factors.
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Affiliation(s)
- Fitsum Weldegebreal
- Department of Medical Laboratory Sciences, College of Health and
Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical
Sciences, Haramaya University, Harar, Ethiopia
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11
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Costa APF, Gonzaga dos Santos M, Sarmento ACA, Alcântara da Silva PH, Chaves GM, Crispim JCDO, Gonçalves AK, Cobucci RNO. Meta-Analysis of The Prevalence of Genital Infections Among Hiv Carriers and Uninfected Women. Open AIDS J 2018. [DOI: 10.2174/1874613601812010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background & Aim:The risk factors in acquiring genital co-infections associated with HIV infection still present many questions. We conducted a systematic review and meta-analysis to compare the prevalence of genital infection among HIV-infected and uninfected women.Methods:We searched PubMed, Web of Science, Scopus and Scielo for the relevant studies up until October 2017. Data were collected from the included studies and methodologically assessed. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using fixed or random-effects models.Results:Thirty-six articles involving 23,863 women with retroviruses were included. HIV-infected women were significantly more diagnosed with the following genital infections:Herpes simplexvirus type 2 (HSV-2) (OR 3.70; 95% CI: 2.42–5.65),Neisseria gonorrhoeae(GC) (OR 4.18; 95% CI: 2.15-8.13),Chlamydia trachomatis(CT) (OR 2.25; 95% CI: 1.20-4.23) and Human papillomavirus (HPV) (OR 3.99, 95% CI: 3.35-4.75). There was no significant difference in the prevalence of bacterial vaginosis (OR 1.09; 95% CI: 0.91-1.30),Candida sp. (OR 1.51; 95% CI: 0.71-3.25),Treponema pallidum(OR 1.56; 95% CI: 1.00-2.45) andTrichomonas vaginalis(OR 1.00; 95% CI: 0.47-2.15).Conclusion:The prevalence of HPV, HSV-2, GC and CT genital infection was significantly higher among HIV-positive women.
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12
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Bateman LB, Blakemore S, Koneru A, Mtesigwa T, McCree R, Lisovicz NF, Aris EA, Yuma S, Mwaiselage JD, Jolly PE. Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow-Up Care and Treatment: Perspectives of Human Immunodeficiency Virus-Positive Women and Health Care Practitioners in Tanzania. Oncologist 2018; 24:69-75. [PMID: 29934410 PMCID: PMC6324638 DOI: 10.1634/theoncologist.2017-0444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 04/10/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study was conducted to identify barriers and facilitators to cervical cancer screening, diagnosis, follow-up care, and treatment among human immunodeficiency virus (HIV)-infected women and clinicians and to explore the acceptability of patient navigators in Tanzania. MATERIALS AND METHODS In 2012, we conducted four focus groups, two with HIV-positive women and two with clinicians who perform cervical cancer screening, diagnosis, follow-up care, and treatment. Transcriptions were analyzed using thematic analysis. RESULTS Findings from the patient focus groups indicate the prevalence of fear and stigma surrounding cervical cancer as well as a lack of information and access to screening and treatment. The clinician focus groups identified numerous barriers to screening, diagnosis, follow-up care, and treatment. Participants in both types of groups agreed that a patient navigation program would be an effective way to help women navigate across the cancer continuum of care including screening, diagnosis, follow-up care, and treatment. CONCLUSION Given the fear, stigma, misinformation, and lack of resources surrounding cervical cancer, it is not surprising that patient navigation would be welcomed by patients and providers. IMPLICATIONS FOR PRACTICE This article identifies specific barriers to cervical cancer screening and treatment from the perspectives of both clinicians and patients in Tanzania and describes the acceptability of the concept of patient navigation.
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Affiliation(s)
| | - Shaundra Blakemore
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Alaya Koneru
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Renicha McCree
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | | | - Eric A Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Safina Yuma
- Reproductive Health Cancer Unit, The United Republic of Tanzania, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Julius D Mwaiselage
- Division for Cancer Prevention and Research, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Pauline E Jolly
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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13
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Looker KJ, Rönn MM, Brock PM, Brisson M, Drolet M, Mayaud P, Boily M. Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status. J Int AIDS Soc 2018; 21:e25110. [PMID: 29873885 PMCID: PMC5989783 DOI: 10.1002/jia2.25110] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/27/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Observational studies suggest HIV and human papillomavirus (HPV) infections may have multiple interactions. We reviewed the strength of the evidence for the influence of HIV on HPV acquisition and clearance, and the influence of HPV on HIV acquisition. METHODS We performed meta-analytic systematic reviews of longitudinal studies of HPV incidence and clearance rate by HIV status (review 1) and of HIV incidence by HPV status (review 2). We pooled relative risk (RR) estimates across studies using random-effect models. I2 statistics and subgroup analyses were used to quantify heterogeneity across estimates and explore the influence of participant and study characteristics including study quality. Publication bias was examined quantitatively with funnel plots and subgroup analysis, as well as qualitatively. RESULTS AND DISCUSSION In review 1, 37 publications (25 independent studies) were included in the meta-analysis. HPV incidence (pooled RR = 1.55, 95% CI: 1.29 to 1.88; heterosexual males: pooled RR = 1.95, 95% CI: 1.62, 2.34; females: pooled RR = 1.63, 95% CI: 1.26 to 2.11; men who have sex with men: pooled RR = 1.36, 95% CI: 1.01 to 1.82) and high-risk HPV incidence (pooled RR = 2.20, 95% CI: 1.90 to 2.54) was approximately doubled among people living with HIV (PLHIV) whereas HPV clearance rate (pooled RR = 0.53, 95% CI: 0.42 to 0.67) was approximately halved. In review 2, 14 publications (11 independent studies) were included in the meta-analysis. HIV incidence was almost doubled (pooled RR = 1.91, 95% CI 1.38 to 2.65) in the presence of prevalent HPV infection. There was more evidence of publication bias in review 2, and somewhat greater risk of confounding in studies included in review 1. There was some evidence that adjustment for key confounders strengthened the associations for review 2. Misclassification bias by HIV/HPV exposure status could also have biased estimates toward the null. CONCLUSIONS These results provide evidence for synergistic HIV and HPV interactions of clinical and public health relevance. HPV vaccination may directly benefit PLHIV, and help control both HPV and HIV at the population level in high prevalence settings. Our estimates of association are useful for mathematical modelling. Although observational studies can never perfectly control for residual confounding, the evidence presented here lends further support for the presence of biological interactions between HIV and HPV that have a strong plausibility.
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Affiliation(s)
- Katharine J Looker
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Minttu M Rönn
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
- Department of Global Health and PopulationHarvard T.H Chan School of Public HealthBostonUSA
| | - Patrick M Brock
- Institute of Biodiversity, Animal Health and Comparative MedicineCollege of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Marc Brisson
- Centre de recherche du CHU de Québec‐Université LavalAxe santé des populations et pratiques optimales en santéQuébecCanada
| | - Melanie Drolet
- Centre de recherche du CHU de Québec‐Université LavalAxe santé des populations et pratiques optimales en santéQuébecCanada
| | - Philippe Mayaud
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
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14
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Travassos AG, Netto E, Xavier-Souza E, Nóbrega I, Adami K, Timbó M, Abbehusen K, Fernandes S, Duran C, Haguihara T, Ferreira F, Brites C. Predictors of HPV incidence and clearance in a cohort of Brazilian HIV-infected women. PLoS One 2017; 12:e0185423. [PMID: 28981551 PMCID: PMC5628817 DOI: 10.1371/journal.pone.0185423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/12/2017] [Indexed: 12/13/2022] Open
Abstract
Persistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher rate of persistent infections and an earlier progression to cancer. We aimed to evaluate HR-HPV prevalence, incidence and clearance, and its association with HIV viral suppression, immunological response and other risk factors among WLHA followed at an STD/HIV reference center. This was a cohort study conducted at a reference center for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months after enrolment, where socio-epidemiological data were obtained. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS® Roche) in addition to blood samples for CD4+ T lymphocyte count and HIV viral load. We prospectively evaluated 333 women. HR-HPV DNA prevalence was 33.3% at baseline. HPV-16 was present in 5.1%, HPV-18 in 3.9% and 29.4% WLHA had other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). The HR-HPV incidence during the follow-up was 10.8%, at the 6-month visit was 7.7% and at the 12-month visit was 3.7%. Variables associated with HR-HPV incidence were: nulliparity, combined oral contraceptive use and detectable HIV viral load. The HR-HPV clearance rate was 41.7% and was associated with age >30 years and lymphocyte T CD4 count >500 cells/mm3 at enrolment. These findings contribute to the knowledge about a group of women that need more careful HPV screening and describe the association between an efficient immunological response and HIV viral suppression with lower incidence and increased clearance of HR-HPV.
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Affiliation(s)
- Ana Gabriela Travassos
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
- Colegiado de Medicina, Departamento de Ciências da Vida, Universidade Estadual da Bahia, Salvador, Bahia, Brazil
| | - Eduardo Netto
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Isabella Nóbrega
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
| | - Karina Adami
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
| | - Maiara Timbó
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Karen Abbehusen
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
| | - Sheyla Fernandes
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
| | - Camila Duran
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Tatiana Haguihara
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, Brazil
| | - Fábio Ferreira
- Laboratório Central de Saúde Pública Prof. Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Carlos Brites
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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15
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Jolly PE, Mthethwa-Hleta S, Padilla LA, Pettis J, Winston S, Akinyemiju TF, Turner HJ, Ejiawoko A, Brooks R, Preko L, Preko PO. Screening, prevalence, and risk factors for cervical lesions among HIV positive and HIV negative women in Swaziland. BMC Public Health 2017; 17:218. [PMID: 28222714 PMCID: PMC5320649 DOI: 10.1186/s12889-017-4120-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/08/2017] [Indexed: 01/20/2023] Open
Abstract
Background Cervical Cancer (CC) is the number one cancer among women in sub-Saharan Africa. Although CC is preventable, most women in developing countries do not have access to screening. Methods This cross-sectional study was conducted to determine the prevalence and risk factors for cervical lesions using visual inspection with acetic acid (VIA) among 112 HIV positive and 161 negative women aged 18–69 years. Results The presence of cervical lesions was greater among HIV positive (22.9%) than HIV negative women (5.7%; p < 0.0001). In logistic models, the risk of cervical lesions among HIV positive women was 5.24 times higher when adjusted by age (OR 5.24, CI 2.31–11.88), and 4.06 times higher in a full model (OR 4.06, CI 1.61–10.25), than among HIV negative women. In the age-adjusted model women who had ≥2 lifetime sexual partners were 3 times more likely (OR 3.00, CI 1.02–8.85) to have cervical lesions compared to women with one lifetime partner and the odds of cervical lesions among women with a history of STIs were 2.16 greater (OR 2.16, CI 1.04–4.50) than among women with no previous STI. In the fully adjusted model women who had a previous cervical exam were 2.5 times more likely (OR 2.53, CI 1.06–6.05) to have cervical lesions than women who had not. Conclusions The high prevalence of HIV infection and the strong association between HIV and cervical lesions highlight the need for substantial scale-up of cervical screening to decrease the rate of CC in Swaziland.
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Affiliation(s)
- Pauline E Jolly
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA.
| | - Simangele Mthethwa-Hleta
- Ministry of Health and Social Welfare, 2nd Floor Ministry of Justice & Constitutional Affairs Building, Mhalambanyatsi Road, Mbabane, Swaziland
| | - Luz A Padilla
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Jessica Pettis
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - ShaCoria Winston
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Tomi F Akinyemiju
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Hannah J Turner
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Amarachi Ejiawoko
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Raina Brooks
- Department of Epidemiology, School of Public Health, Ryals Public Health Building, University of Alabama at Birmingham, 1665 University Boulevard Birmingham, Birmingham, AL, 35294-0022, USA
| | - Lena Preko
- Swaziland Breast and Cervical Cancer Network (SBCN), Stall A31 Printpak Building, Industrial Site, Sheffield Road, Mbabane, Swaziland
| | - Peter O Preko
- Care and Treatment Lead for the President's Emergency Plan for AIDS Relief (PEPFAR), Jubela Street, Kent Rock, Mbabane, Swaziland
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Mane A, Sahasrabuddhe VV, Nirmalkar A, Risbud AR, Sahay S, Bhosale RA, Vermund SH, Mehendale SM. Rates and determinants of incidence and clearance of cervical HPV genotypes among HIV-seropositive women in Pune, India. J Clin Virol 2016; 88:26-32. [PMID: 28152432 DOI: 10.1016/j.jcv.2016.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several studies in recent years have documented the genotype-specific prevalence of HPV infection and wide diversity and multiplicity of HPV genotypes among HIV-seropositive women. Yet, information on changes in HPV genotype-specific incidence and clearance rates over time, and their correlation with clinical or immunologic factors among HIV-seropositive women is scarce. OBJECTIVES We conducted a prospective study to investigate the incidence and clearance rates of cervical HPV genotypes among HIV-seropositive women in India and expand the evidence base in this area of research. STUDY DESIGN Cervical samples were collected from n=215 HIV-seropositive women in Pune, India who underwent two screening visits separated by a median of 11-months (interquartile range: 8-18 months). HPV genotypes were determined by Roche Linear Array HPV assay. Individual genotype-specific and carcinogenicity-grouping-specific HPV incidence and clearance rates were calculated and the associations between incidence/clearance and age and HIV-related metrics were explored. RESULTS Incidence and clearance rates for 'any HPV' and 'carcinogenic HPV' genotypes were 11.1 and 18.3, and 6.7 and 33.8, per 100 person-years, respectively. Incidence and clearance rates for HPV genotypes of alpha-9 species (HPV16, HPV31, HPV33, HPV35, HPV52 and HPV58) and alpha-7 species (HPV18, HPV39, HPV45, HPV59 and HPV68) were 5.8 and 2.04, and 32.1 and 53.5, per 100 person-years, respectively. Clearance of any HPV type was associated with increasing age of participants (odds ratio: 1.08, 95%CI: 1.004-1.17), although the association marginally lost its statistical significance when adjusted for CD4 counts and antiretroviral therapy status. CONCLUSIONS Genotype-specific clearance rates of HPV were higher than corresponding incidence rates. The suggestion of a positive associations of increasing age with HPV clearance points to the need for etiologic studies on age-related hormonal changes on clearance of cervical HPV infection.
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Affiliation(s)
- Arati Mane
- National AIDS Research Institute, Pune, India
| | | | | | | | - Seema Sahay
- National AIDS Research Institute, Pune, India
| | | | - Sten H Vermund
- Vanderbilt University School of Medicine, Nashville, USA
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17
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Kolawole OE, Kola OJ, Hilda AE, Ayodeji AT, Olubunmi AD, Abayomi AO, Adekeye EA. Detection of Human Papilloma Virus (Type 16) among HIV-Positive Women in Ogbomoso, South-Western Nigeria. J Immunoassay Immunochem 2016; 37:130-40. [PMID: 26327516 DOI: 10.1080/15321819.2015.1065271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Human papilloma virus (HPV) is a common sexually transmitted virus which infects the cutaneous and mucosal epithelium. HPV Type 16 is one of the viruses that causes cervical cancer and immunocompromised individuals are at high risk of different co-infections. Women living with Human Immunodeficiency Virus (HIV) have greater risk to the virus due to their impaired immunity. This study aimed at determining the seroprevalence of HPV IgM (Type 16) among HIV-infected women in Ogbomoso. METHODS The blood sample of 180 consenting subjects were obtained and their sera subjected to serological assay using Enzyme Linked Immunosorbent Assay. Samples were collected over a period of 6 months (July-December 2014). RESULTS The mean age and mean CD4+ count of the subjects was 38.22 ± 0.79 years and 392.80 ± 20.98 cells/μL, respectively. Out of 180 subjects tested, 18 (10%; 95% confidence interval) were positive for HPV Type 16 IgM. HPV Type 16 IgM was highest among the age group 31-45 (61.11%), traders (38.89%), >500 CD4/μL (33.33%). The seroprevalence using logistic regression at P < 0.05 shows there is a significant difference between the age and CD4 (+) cell count. CONCLUSION The result provides evidence that HPV Type 16 is present among HIV-infected women in Ogbomoso and they are susceptible to cervical cancer. This seroepidemiological survey is important for the prevention efforts such as availability of vaccine.
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Affiliation(s)
- O E Kolawole
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - O J Kola
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - A E Hilda
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - A T Ayodeji
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - A D Olubunmi
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - A O Abayomi
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
| | - E A Adekeye
- a Department of Pure and Applied Biology, Microbiology/Virology Unit , Ladoke Akintola University of Technology, Ogbomoso , Oyo State , Nigeria
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Abstract
OBJECTIVE The implication of human papilloma virus (HPV) in head and neck squamous cell carcinoma (HNSCC) is well established, especially in oropharyngeal SCC. HIV patients have a higher risk of persistent HPV infection. We investigated the role of HPV in HNSCC carcinogenesis in HIV population. DESIGN Retrospective monocentric study. METHODS We studied HIV patients who presented with HNSCC between 1994 and 2014. For each patient, tumor characteristics, HIV disease, and survival information were collected. Tumor HPV testing was performed using p16 immunohistochemistry (IHC), in-situ hybridization and PCR. We assessed the percentage of HPV in this population of HIV patients with HNSCC and compared HIV disease characteristics based on HPV status. RESULTS Forty-seven patients were included: 11 women/36 men, the median age was 50 years. Tumor HPV testing was performed in 40 patients. Tumors were located in oropharynx (32%), oral cavity (32%), larynx (21%), and hypopharynx (11%). At the time of diagnosis, median CD4 level was 385 cells/μl, 31% of the patients were stage (Centers for Disease Control, stage C). The percentage of HPV linked to HNSCC for all locations in HIV patients was 30% (n = 12). HPV16 accounted for 50% of all HPV genotypes. HPV positive status was associated with a CD4 nadir of less than 200 (P = 0.026), but not with CD4 level at time of diagnosis (P = 0.414). HPV-negative tumors tend to be associated with poorer 5-year overall survival (hazard ratio = 2.9, P = 0.0711). CONCLUSION HPV plays a critical role in HNSCC development in HIV population. HIV immunodeficiency may increase HPV persistence and progression of HNSCC.
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Plotkin M, Besana GVR, Yuma S, Kim YM, Kulindwa Y, Kabole F, Lu E, Giattas MR. Integrating HIV testing into cervical cancer screening in Tanzania: an analysis of routine service delivery statistics. BMC Womens Health 2014; 14:120. [PMID: 25271025 PMCID: PMC4190378 DOI: 10.1186/1472-6874-14-120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the lifetime risk of developing cervical cancer (CaCx) and acquiring HIV is high for women in Tanzania, most women have not tested for HIV in the past year and most have never been screened for CaCx. Good management of both diseases, which have a synergistic relationship, requires integrated screening, prevention, and treatment services. The aim of this analysis is to assess the acceptability, feasibility and effectiveness of integrating HIV testing into CaCx prevention services in Tanzania, so as to inform scale-up strategies. METHODS We analysed 2010-2013 service delivery data from 21 government health facilities in four regions of the country, to examine integration of HIV testing within newly introduced CaCx screening and treatment services, located in the reproductive and child health (RCH) section of the facility. Analysis included the proportion of clients offered and accepting the HIV test, reasons why testing was not offered or was declined, and HIV status of CaCx screening clients. RESULTS A total of 24,966 women were screened for CaCx; of these, approximately one-quarter (26%) were referred in from HIV care and treatment clinics. Among the women of unknown HIV status (n = 18,539), 60% were offered an HIV test. The proportion of women offered an HIV test varied over time, but showed a trend of decline as the program expanded. Unavailability of HIV test kits at the facility was the most common reason for a CaCx screening client not to be offered an HIV test (71% of 6,321 cases). Almost all women offered (94%) accepted testing, and 5% of those tested (582 women) learned for the first time that they were HIV-positive. CONCLUSION Integrating HIV testing into CaCx screening services was highly acceptable to clients and was an effective means of reaching HIV-positive women who did not know their status; effectiveness was limited, however, by shortages of HIV test kits at facilities. Integration of HIV testing into CaCx screening services should be prioritized in HIV-endemic settings, but more work is needed to eliminate logistical barriers. The coverage of CaCx screening among HIV care and treatment-enrolled women in Tanzania may be low and should be examined.
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Affiliation(s)
- Marya Plotkin
- />Jhpiego, New Bagamoyo Road, P.O. Box 9170, Dar es Salaam, Tanzania
| | - Giulia VR Besana
- />Jhpiego, New Bagamoyo Road, P.O. Box 9170, Dar es Salaam, Tanzania
| | - Safina Yuma
- />Ministry of Health and Social Welfare, Reproductive Health Cancer Unit, Dar es Salaam, Tanzania
| | | | - Yusuph Kulindwa
- />Jhpiego, New Bagamoyo Road, P.O. Box 9170, Dar es Salaam, Tanzania
| | - Fatma Kabole
- />Jhpiego, New Bagamoyo Road, P.O. Box 9170, Dar es Salaam, Tanzania
| | - Enriquito Lu
- />Ministry of Health and Social Welfare, Reproductive Health Cancer Unit, Dar es Salaam, Tanzania
| | - Mary Rose Giattas
- />Jhpiego, New Bagamoyo Road, P.O. Box 9170, Dar es Salaam, Tanzania
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Woods RSR, O’Regan EM, Kennedy S, Martin C, O’Leary JJ, Timon C. Role of human papillomavirus in oropharyngeal squamous cell carcinoma: A review. World J Clin Cases 2014; 2:172-193. [PMID: 24945004 PMCID: PMC4061306 DOI: 10.12998/wjcc.v2.i6.172] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/21/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Human papillomavirus (HPV) has been implicated in the pathogenesis of a subset of oropharyngeal squamous cell carcinoma. As a result, traditional paradigms in relation to the management of head and neck squamous cell carcinoma have been changing. Research into HPV-related oropharyngeal squamous cell carcinoma is rapidly expanding, however many molecular pathological and clinical aspects of the role of HPV remain uncertain and are the subject of ongoing investigation. A detailed search of the literature pertaining to HPV-related oropharyngeal squamous cell carcinoma was performed and information on the topic was gathered. In this article, we present an extensive review of the current literature on the role of HPV in oropharyngeal squamous cell carcinoma, particularly in relation to epidemiology, risk factors, carcinogenesis, biomarkers and clinical implications. HPV has been established as a causative agent in oropharyngeal squamous cell carcinoma and biologically active HPV can act as a prognosticator with better overall survival than HPV-negative tumours. A distinct group of younger patients with limited tobacco and alcohol exposure have emerged as characteristic of this HPV-related subset of squamous cell carcinoma of the head and neck. However, the exact molecular mechanisms of carcinogenesis are not completely understood and further studies are needed to assist development of optimal prevention and treatment modalities.
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Njagi SK, Mugo NR, Reid AJ, Satyanarayana S, Tayler-Smith K, Kizito W, Kwatampora J, Waweru W, Kimani J, Smith JS. Prevalence and incidence of cervical intra-epithelial neoplasia among female sex workers in Korogocho, Kenya. Public Health Action 2013; 3:271-5. [PMID: 26393045 DOI: 10.5588/pha.13.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/03/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya. OBJECTIVE In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012. DESIGN Prospective nested cohort study. RESULTS Of the 350 women enrolled, the median age was 29 years (range 18-49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infected women were 2.7 times (95%CI 1.7-4.4) more likely to have CIN than non-HIV-1-infected women. Among HIV-1-infected women, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2-5.1) and seven times (95%CI 2.3-23.3) greater than among non-HIV-infected women. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infected women. CONCLUSION The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.
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Affiliation(s)
- S K Njagi
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - N R Mugo
- Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya
| | - A J Reid
- Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - K Tayler-Smith
- Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg
| | - W Kizito
- Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg
| | - J Kwatampora
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - W Waweru
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - J Kimani
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - J S Smith
- University of North Carolina, Chapel Hill, North Carolina, USA
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Jalil EM, Bastos FI, Melli PPDS, Duarte G, Simoes RT, Yamamoto AY, Morais RAAD, Quintana SM. HPV clearance in postpartum period of HIV-positive and negative women: a prospective follow-up study. BMC Infect Dis 2013; 13:564. [PMID: 24289532 PMCID: PMC4219400 DOI: 10.1186/1471-2334-13-564] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 11/26/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND HPV persistence is a key determinant of cervical carcinogenesis. The influence of postpartum on HPV clearance has been debated. This study aimed to assess HPV clearance in later pregnancy and postpartum among HIV-positive and negative women. METHODS We conducted a follow-up study with 151 HPV-positive women coinfected with HIV, in 2007-2010. After baseline assessment, all women were retested for HPV infection using PCR in later pregnancy and after delivery. Multivariable logistic regressions assessed the putative association of covariates with HPV status in between each one of the successive visits. RESULTS Seventy-one women (47%) have eliminated HPV between the baseline visit and their second or third visits. HIV-positive women took a significantly longer time (7.0 ± 3.8 months) to clear HPV, compared to those not infected by HIV (5.9 ± 3.0 months). HPV clearance was significantly more likely to take place after delivery than during pregnancy (84.5% x 15.5%). CONCLUSIONS Both HIV-positive and negative women presented a significant reduction in HPV infection during the postpartum period. HIV-positive status was found to be associated with a longer period of time to clear HPV infection in pregnant women.
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Affiliation(s)
- Emilia Moreira Jalil
- ICICT/ENSP - Fundação Oswaldo Cruz - FIOCRUZ, Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro RJ 21045-900, Brazil
| | - Francisco Inacio Bastos
- ICICT/ENSP - Fundação Oswaldo Cruz - FIOCRUZ, Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro RJ 21045-900, Brazil
- CAPES Visiting scholar, Imperial College London, London, UK
| | | | - Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Sao Paulo, Brazil
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Rositch AF, Koshiol J, Hudgens MG, Razzaghi H, Backes DM, Pimenta JM, Franco EL, Poole C, Smith JS. Patterns of persistent genital human papillomavirus infection among women worldwide: a literature review and meta-analysis. Int J Cancer 2013; 133:1271-85. [PMID: 22961444 PMCID: PMC3707974 DOI: 10.1002/ijc.27828] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 08/21/2012] [Indexed: 12/14/2022]
Abstract
Persistent high-risk human papillomavirus (HR-HPV) infection is the strongest risk factor for high-grade cervical precancer. We performed a systematic review and meta-analysis of HPV persistence patterns worldwide. Medline and ISI Web of Science were searched through January 1, 2010 for articles estimating HPV persistence or duration of detection. Descriptive and meta-regression techniques were used to summarize variability and the influence of study definitions and characteristics on duration and persistence of cervical HPV infections in women. Among 86 studies providing data on over 100,000 women, 73% defined persistence as HPV positivity at a minimum of two time points. Persistence varied notably across studies and was largely mediated by study region and HPV type, with HPV-16, 31, 33 and 52 being most persistent. Weighted median duration of any-HPV detection was 9.8 months. HR-HPV (9.3 months) persisted longer than low-risk HPV (8.4 months), and HPV-16 (12.4 months) persisted longer than HPV-18 (9.8 months). Among populations of HPV-positive women with normal cytology, the median duration of any-HPV detection was 11.5 and HR-HPV detection was 10.9 months. In conclusion, we estimated that approximately half of HPV infections persist past 6 to 12 months. Repeat HPV testing at 12-month intervals could identify women at increased risk of high-grade cervical precancer due to persistent HPV infections.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Chen YC, Liu HY, Li CY, Lee NY, Ko WC, Chou CY, Hsieh TH, Ko NY. Low Papanicolaou smear screening rate of women with HIV infection: a nationwide population-based study in Taiwan, 2000-2010. J Womens Health (Larchmt) 2013; 22:1016-22. [PMID: 23992102 DOI: 10.1089/jwh.2012.4127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Women infected by human immunodeficiency virus (HIV) have a higher risk of contracting cervical cancer. Recent guidelines recommend that all HIV-positive women should receive two Pap smears in the first year after their HIV diagnosis. METHODS This was a population-based cohort study, and the National Health Insurance Research Database (NHIRD) in Taiwan was used to estimate the Pap smear screening rate for 1449 HIV-infected women aged 18 years and over from 2000 to 2010. A multiple logistic regression analysis was used to identify factors associated with HIV-infected women who had received Pap smears. RESULTS Of 1449 women, 618 (43%) women received at least one Pap smear. Only 14.7% of the HIV-infected women received Pap smears within one year after being diagnosed with HIV. A logistic regression analysis showed that the factors associated with receiving at least one Pap smear after HIV diagnosis were increasing age (AOR 1.04, 95% CI 1.03-1.05), high monthly income (AOR 1.83, 95% CI 1.51-2.23), any history of antiretroviral therapy (AOR 1.78, 95% CI 1.38-2.29), retention in HIV care (AOR 1.36, 95% CI 1.04-1.77), a history of sexually transmitted diseases (AOR 1.96, 95% CI 1.50-2.56), and any history of treatment for opportunistic infections (AOR 2.46, 95% CI 1.91-3.16). CONCLUSIONS A great need exists to develop strategies for promoting receipt of Pap smear screening services that specifically target severely disadvantaged women with HIV, particularly younger, lower income women and those in an asymptomatic phase.
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Affiliation(s)
- Yen-Chin Chen
- 1 Department of Nursing, National Cheng Kung University and Hospital , Tainan, Taiwan
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25
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Denslow SA, Rositch AF, Firnhaber C, Ting J, Smith JS. Incidence and progression of cervical lesions in women with HIV: a systematic global review. Int J STD AIDS 2013; 25:163-77. [PMID: 24216030 DOI: 10.1177/0956462413491735] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Global data on cervical lesion incidence and progression in HIV-positive women are essential for understanding the natural history of cervical neoplasia and informing screening policy. A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Of 5882 HIV-positive women from 15 studies, incidence ranged from 4.9 to 21.1 cases per 100 woman-years for any cervical lesion and 0.4 to 8.8 cases per 100 woman-years for high-grade cervical lesions. HIV-positive women showed a median three-fold higher incidence of cervical lesions compared to HIV-negative women. Of 1099 HIV-positive women from 11 studies, progression from low- to high-grade lesions ranged from 1.2 to 26.2 cases per 100 woman-years. Both incidence and progression rates increased with lower CD4 counts. The effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear. HIV-positive women have higher incidence and progression of cervical neoplasia. Cervical cancer screening should be integrated into HIV treatment programmes.
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Affiliation(s)
- Sheri A Denslow
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Beachler DC, D'Souza G, Sugar EA, Xiao W, Gillison ML. Natural history of anal vs oral HPV infection in HIV-infected men and women. J Infect Dis 2013; 208:330-9. [PMID: 23596319 DOI: 10.1093/infdis/jit170] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected individuals are at greater risk for human papillomavirus (HPV)-associated anal than oropharyngeal cancers. The prevalence of anal vs oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown. METHODS Oral rinse and anal swab samples were collected semiannually from 404 HIV-infected adults in Baltimore, Maryland. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models. RESULTS The prevalence (84% vs 28%), incidence (145 vs 31 per 1000 person-months), and 12-month persistence (54% vs 29%) were higher for anal vs oral HPV infections, respectively (each P < .001). Heterosexual men had lower incidence of anal HPV than men who have sex with men and women, but a higher incidence of oral HPV infection (test of interaction P < 0.001). In adjusted analyses, risk factors for HPV persistence included prevalent vs incident (adjusted hazard ratio [aHR] = 4.0; 95% confidence interval [CI], 3.5-4.8) and anal vs oral HPV infections (aHR = 1.5; 95% CI, 1.2-1.9). CONCLUSIONS The higher incidence and persistence of anal vs oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV-infected individuals.
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Affiliation(s)
- Daniel C Beachler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Swende TZ, Ngwan SD, Swende LT. Prevalence and risk factors for cervical squamous intraepithelial lesions among women infected with HIV-1 in Makurdi, Nigeria. Int J Womens Health 2012; 4:55-60. [PMID: 22393304 PMCID: PMC3292404 DOI: 10.2147/ijwh.s21205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among women infected with human immunodeficiency virus type 1 (HIV-1) receiving care at the Federal Medical Center Makurdi, Nigeria. Methods Between March and December 2009, a total of 253 women infected with HIV-1 had cervical smears taken for cytology. HIV-1 RNA viral load and CD4 counts were also measured. Results Of the 253 women, cervical SIL were present in 45 (17.8%). However, abnormal cervical cytology was noted in 146 (57.7%). Of those with abnormal cervical cytology, 101 (39.9%) women had atypical squamous cells of undetermined significance, 16 (6.3%) had low-grade SIL, and 29 (11.5%) women had high-grade SIL. The median CD4 lymphocyte count was lower in participants with cervical SIL compared with those without (132 versus 184 cells/mm3; P = 0.03). The median HIV-1 RNA viral load was higher in women with cervical SIL (102,705 versus 64,391 copies/mL; P = 0.02). A CD4 lymphocyte count of <200 cells/mm3 and an HIV-1 RNA viral load of <10,000 copies/mL were found to be significantly associated with cervical SIL. Conclusion A high prevalence of cervical SIL was found among HIV-1-infected women in Makurdi, Nigeria. Increased immune suppression and HIV-1 viremia are significantly associated with cervical SIL.
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Affiliation(s)
- Terrumun Z Swende
- Department of Obstetrics and Gynecology, College of Health Sciences, Benue State University, Makurdi
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Rosa MI, Moraes MV, Vuolo F, Petronilho F, Bozzetti MC, Medeiros LR, Igansi CN, Silva FR, Dal-Pizzol F, Rosa DD. Association of interleukin-6 in women with persistence of DNA-HPV: a nested case-control study. Arch Gynecol Obstet 2011; 285:143-8. [PMID: 21611774 DOI: 10.1007/s00404-011-1925-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify the role of Interleukin-6, IL-10 and their epidemiological association in women with persistence of DNA-HPV. DESIGN AND METHODS A nested case-control study within a longitudinal cohort study. Cervical specimens and blood samples were collected at enrolment from asymptomatic women who looked for a service of public health in a district of Porto Alegre, Brazil. A logistic regression analysis was performed with 95% confidence intervals. The outcome was the persistence of DNA-HPV infection. RESULTS The analysis showed that the age of the first intercourse below 20 years old (OR = 19.65, IC 95% 2.43-68.85), four or more sexual partners during lifetime (OR = 5.67, IC 95% 1.28-24.99), women with a previous altered Pap smear (OR = 10.17, IC 95% 1.80-57.33), marital status (OR = 12.94, IC 95% 2.43-68.85) and IL6 ≤ 3.106 pg/ml were associated with persistence of HPV infection. IL-10 were not associated with the HPV persistence. CONCLUSION The present study suggests that IL-6 levels may be a marker of HPV DNA persistence, although further investigation is necessary.
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Affiliation(s)
- Maria Inês Rosa
- Laboratory of Epidemiology and National Institute for Translational Medicine, Postgraduate Program in Health Sciences, University of the Extreme-South Catarinense, Criciuma, Brazil.
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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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Incidence of non-AIDS-defining malignancies in HIV-infected versus noninfected patients in the HAART era: impact of immunosuppression. J Acquir Immune Defic Syndr 2010; 52:203-8. [PMID: 19617846 DOI: 10.1097/qai.0b013e3181b033ab] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of non-AIDS-defining malignancies (non-ADMs) is reported as unchanged or increasing in the highly active antiretroviral therapy era. Whether incidence of non-ADM is significantly higher in HIV-infected than in HIV-uninfected patients remains unclear. METHODS Incidence rates of malignancies were calculated in a cohort of veterans in care for HIV-infected and age, race, and gender-matched uninfected patients from 1997 to 2004. For HIV-infected patients, CD4 counts closest to first observation date were compared between those with and without cancer. RESULTS Thirty three thousand four hundred twenty HIV-infected and 66,840 HIV-uninfected patients were followed for a median of 5.1 and 6.4 years. The incidence rate ratio of HIV infected to HIV uninfected was 1.6 (1260 vs. 841 per 100,000 person-years; 95% confidence interval: 1.5 to 1.7). Incidence rate ratio for individual cancers was highest for anal cancer (14.9; confidence interval: 10.1 to 22.1). Among HIV-infected patients, median CD4 counts were lower for those with non-ADM (249 vs. 270, P = 0.02), anal cancer (156 vs. 270; P < 0.001), and Hodgkin lymphoma (217 vs. 269; P = 0.03). Prostate cancer was associated with a higher CD4 count (311 vs. 266; P < 0.001). CONCLUSIONS In the highly active antiretroviral therapy era, the incidence of non-ADMs is higher among HIV-infected than HIV-uninfected patients, adjusting for age, race, and gender. Some non-ADMs do not seem to be associated with significantly lower CD4 counts.
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A randomized, placebo-controlled, dose-escalation study to determine the safety, tolerability, and immunogenicity of an HPV-16 therapeutic vaccine in HIV-positive participants with oncogenic HPV infection of the anus. J Acquir Immune Defic Syndr 2009; 52:371-81. [PMID: 19661810 DOI: 10.1097/qai.0b013e3181b7354c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Study aimed to assess safety, tolerability, and immunogenicity of novel therapeutic HPV-16 E6E7 ISCOMATRIX vaccine for treatment of human papilloma virus (HPV)-related anal intraepithelial neoplasia in HIV-infected men who have sex with men with moderate immunosuppression. DESIGN Randomized, multicenter, blinded, placebo-controlled, dose-escalating study investigating 3 different doses of vaccine and different dose schedule. Primary objective to determine safety and tolerability, including clinical status, maintenance of virological control, and CD4 cell count for more than 252 days. RESULTS Thirty-five men who have sex with men enrolled; median age 47 years; current CD4 count 627 cells per milliliter; nadir CD4 count 154 cells per milliliter; 94% current antiretrovirals; 100% high-risk HPV types; 69% abnormal anal cytology; and 34% anal intraepithelial neoplasia 1-3 on high-resolution anoscopy. No dose-limiting toxicities or serious adverse events in HPV-16 vaccine recipients. Most HPV-16 vaccine recipients reported moderate/severe short-term injection site reactions and systemic reactions including headache, myalgia, and fatigue. CD4 cell counts remained stable. Five participants had transiently detectable viral loads. Ninety-six percent of vaccine recipients had at least a 4-fold increase in HPV-16 antibody from prevaccination levels. Seventy-one percent had at least a 3-fold increase in interferon-gamma responses to E6E7 peptides. CONCLUSIONS The novel therapeutic HPV-16 E6E7 ISCOMATRIX vaccine seemed safe and reasonably well tolerated. The therapeutic vaccine induces strong and durable antibody responses and moderate interferon-gamma levels that fell to prevaccination levels by week 24.
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Prevalence and persistence of cervical human papillomavirus infection in HIV-positive women initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 51:274-82. [PMID: 19387354 DOI: 10.1097/qai.0b013e3181a97be5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of human papillomavirus (HPV) DNA in cervical specimens from treatment-naive women initiating highly active antiretroviral therapy (HAART) and explore the longitudinal association of HPV DNA with CD4 count and HIV viral load (VL). METHODS Women enrolled before HAART were evaluated at baseline, weeks 24, 48, and 96 with CD4 count, VL, and cervical swab for HPV DNA. RESULTS The 146 subjects had a median CD4 count of 238 cells per microliter and VL of 13,894 copies per milliliter. Ninety-seven subjects (66%) had HPV DNA detected in the baseline specimen including 90 subjects (62%) positive for 1 or more high-risk HPV types. HPV DNA detection declined to 49% at week 96 and that of a high risk HPV type to 39%. The duration of follow-up was associated with decreased detection of HPV DNA of any type (P = 0.045) and of high-risk HPV types (P = 0.003). There was at most a marginal association between HAART response and loss of detection of cervical HPV DNA. CONCLUSIONS Women initiating HAART had a high prevalence of cervical HPV DNA that declined over 96 weeks of HAART. The relationship of CD4 count and VL response to the decline of cervical HPV DNA was not strong.
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Moodley M, Mould S. Invasive cervical cancer and human immunodeficiency virus (HIV) infection in KwaZulu-Natal, South Africa. J OBSTET GYNAECOL 2009; 25:706-10. [PMID: 16263548 DOI: 10.1080/01443610500294599] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The human immunodeficiency virus (HIV) can be expected to influence the course of disease and response to treatment of invasive carcinoma of the cervix. The extent and nature of this influence, however remains largely unknown. We therefore undertook a retrospective analysis of patients with carcinoma of the cervix at a tertiary referral centre in an African setting where HIV prevalence is high. There were 271 patients seen during a period of 1 year. Of these, 45 of the 206 tested were HIV infected (21.8%). The corresponding HIV prevalence for antenatal attendees was 38.7% in the region. The HIV-infected patients had lower mean haemoglobin levels and body mass indices than the HIV-non-infected women and were on average 13 years younger (p < 0.001), but otherwise did not differ with respect to demographics or disease parameters. They were, however, less likely to complete planned treatment. CD4 counts were below 200 in only 6 (21%) of 29 women tested. HIV-infected women in the African setting present with carcinoma of the cervix at a younger age, but the same disease stage as HIV-non-infected women, and without evidence of advanced immunocompromise. Circumstantial evidence is put forward by the study to suggest a more rapid decline in health and earlier demise for HIV-infected women with carcinoma of the cervix.
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Affiliation(s)
- M Moodley
- Gynaecology Oncology, Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, South Africa.
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Epidemiological data of different human papillomavirus genotypes in cervical specimens of HIV-1-infected women without history of cervical pathology. J Acquir Immune Defic Syndr 2009; 50:168-75. [PMID: 19131892 DOI: 10.1097/qai.0b013e3181938e63] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM To study the epidemiology of different human papillomavirus (HPV) genotypes in cervical samples of HIV-1-infected women with normal Papanicolau smears. DESIGN : Retrospective analysis of a prospective cohort. PATIENTS AND METHODS We selected HIV-1-infected women with 2 consecutive normal Papanicolau smears at baseline and at least 1 baseline and 1 follow-up cervical sample. HPV infection was assessed by second-generation hybrid capture (HC-2) and multiplex polymerase chain reaction (mPCR). HPV genotypes were determined by mPCR. RESULTS From a cohort of 139 women followed up to 4 years, 93 women meeting the inclusion criteria were analyzed. The mean period between samples was 20 months (range, 6-44 months). HPV baseline prevalence was 63% [59/93; 95% confidence interval (CI), 53% to 73%] using polymerase chain reaction and 41% (38/93; 95% CI, 31% to 51%) using HC-2, P = 0.007 (kappa, 0.45; P = 0.001). The most prevalent high oncogenic risk genotypes (HR-HPV) were HPV-16 (28%), HPV-33 (18%), HPV-52 (12%), HPV-58 (11%), and HPV-39 (11%). Infection with multiple HPV genotypes was detected in >40% of women. HPV infection persisted at follow-up in 86% (51/59; 95% CI, 77% to 95%) by polymerase chain reaction and 76% (29/38; 95% CI, 62% to 90%) by HC-2. HPV infection persisted in 55% of women with samples available beyond 3 years. The actuarial probabilities of clearance and incidence of HPV infection at 36 months were 16% and 45%, respectively. CONCLUSIONS HPV infection is highly prevalent and persistent among HIV-1-infected women with normal Papanicolau smears. HR-HPV genotypes other than HPV-16 (HPV-33, HPV-52) are frequently detected in HIV-infected women. mPCR provides better surveillance of HPV infection than HC-2 methods.
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Smith JS, Melendy A, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health 2008; 43:S5-25, S25.e1-41. [PMID: 18809145 DOI: 10.1016/j.jadohealth.2008.07.009] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 06/27/2008] [Accepted: 07/03/2008] [Indexed: 01/08/2023]
Abstract
PURPOSE Global data on age-specific prevalence of human papillomavirus (HPV) infection overall, and for high-risk HPV types 16 and 18, are essential for the future implementation of HPV prophylactic vaccines for cervical cancer prevention. METHODS A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in women. Studies with clear descriptions of polymerase chain reaction or hybrid capture detection assays were included. RESULTS A total of 346,160 women were included in 375 studies. Of 134 studies with age-stratified HPV prevalence data (116 low sexual risk populations, 18 high sexual risk populations), over 50% were from Europe and the Middle East (38%) and North America (19%), with smaller proportions from Asia and Australia (21%), Central and South America (11%), and Africa (10%). Across all geographical regions, data on HPV prevalence were generally limited to women over 18 years of age. Consistently across studies, HPV infection prevalence decreased with increasing age from a peak prevalence in younger women (< or =25 years of age). In middle-aged women (35-50 years), maximum HPV prevalence differed across geographical regions: Africa (approximately 20%), Asia/Australia (approximately 15%), Central and South America (approximately 20%), North America (approximately 20%), Southern Europe/Middle East (approximately 15%), and Northern Europe (approximately 15%). Inconsistent trends in HPV prevalence by age were noted in older women, with a decrease or plateau of HPV prevalence in older ages in most studies, whereas others showed an increase of HPV prevalence in older ages. Similar trends of HPV 16 and/or 18 prevalence by age were noted among 12 populations with available data. DISCUSSION Genital HPV infection in women is predominantly acquired in adolescence, and peak prevalence in middle-aged women appears to differ across geographical regions. Worldwide variations in HPV prevalence across age appear to largely reflect differences in sexual behavior across geographical regions. Further studies of HPV prevalence in adolescents are needed for all geographic regions.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Adam Y, van Gelderen CJ, de Bruyn G, McIntyre JA, Turton DA, Martinson NA. Predictors of persistent cytologic abnormalities after treatment of cervical intraepithelial neoplasia in Soweto, South Africa: a cohort study in a HIV high prevalence population. BMC Cancer 2008; 8:211. [PMID: 18657270 PMCID: PMC2515323 DOI: 10.1186/1471-2407-8-211] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 07/25/2008] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the presence of both HIV infection and cervical intraepithelial neoplasia (CIN), the risk of cancer development despite treatment may be greater. We investigated clinical predictors of persistent cytological abnormalities in women who had had a large loop excision of the transformation zone (LLETZ). METHODS Women with high grade squamous intraepithelial lesions or worse (HSIL), less severe abnormalities which persisted and any abnormality in women who are HIV-infected, were referred to the colposcopy clinic. HIV infection was ascertained by self-report. A LLETZ was performed on all patients with HSIL or higher on Papanicolaou (Pap) smear or colposcopy, LSIL or higher in patients who are HIV-infected, where the colposcopy is inadequate, and when there was a discrepancy between colposcopy and cytology by one or more grades. Women with abnormal follow-up smears were compared to those with normal smears. We examined the association between abnormal follow-up smears and demographic and clinical predictors using logistic regression RESULTS The median time between LLETZ and first follow-up Pap smear was rather short at 122 days. Persistent cytological abnormalities occurred in 49% of our patients after LLETZ. Predictors of persistence included the presence of disease at both margins and HIV infection. Among the latter, disease at the excision margins and CD4+ cell count were important predictors. In these women, disease at the endocervical margin, both margins, and disease only at the ectocervical margin were associated with increased odds of persistent abnormalities on follow-up cervical smear. CONCLUSION We showed extremely high risk of cytological abnormality at follow-up after treatment more so in patients with incomplete excision and in the presence of immunocompromise. It remains uncertain whether recurrent CIN is a surrogate marker for invasive cervical cancer.
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Affiliation(s)
- Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
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Giorgi C, Di Bonito P, Grasso F, Mochi S, Accardi L, Donà MG, Branca M, Costa S, Mariani L, Agarossi A, Ciotti M, Syrjänen K. Clinical and epidemiological correlates of antibody response to human papillomaviruses (HPVs) as measured by a novel ELISA based on denatured recombinant HPV16 late (L) and early (E) antigens. Infect Agent Cancer 2008; 3:9. [PMID: 18582363 PMCID: PMC2474580 DOI: 10.1186/1750-9378-3-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 06/26/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND At present, seroreactivity is not a valuable parameter for diagnosis of Human Papillomavirus (HPV) infection but, it is potentially valuable as marker of viral exposure in elucidating the natural history of this infection. More data are needed to asses the clinical relevance of serological response to HPV. OBJECTIVES The objective was to assess the clinical and epidemiological correlates of HPV-seroreactivity in a cohort of HIV-negative and HIV-positive women. METHODS Seroreactivity of 96 women, evaluated in an ELISA test based on denatured HPV16 late (L) and early (E) antigens, was correlated with their clinical and epidemiological data previously collected for a multi-centre Italian study, HPV-PathogenISS study. RESULTS No significant correlation was found between HPV DNA detection and seroreactivity. Women, current smokers showed significantly less seroreactivity to L antigens as compared with the non-smokers. HIV-positive women showed significantly less (66.7%) antibody response as compared with HIV-negative women (89.3%), with particularly impaired response to L antigens. Women, HIV-positive and current smokers, showed by far the lowest seroprevalence (33.3%) as compared to 75.9% among all other women (OR = 0.158; 95%CI 0.036-0.695, p = 0.014; Fisher's exact test). Importantly, this association did not loose its significance when controlled for confounding from age (continuous variable) in multivariate analysis or using Mantel-Haenszel test for age-groups. CONCLUSION It is tempting to speculate that HIV-positive current smokers comprise a special high-risk group, with highly impaired immunological response that could prevent eradication of persistent HPV infections and thus contribute to development of CIN3/CC.
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Affiliation(s)
- Colomba Giorgi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Paola Di Bonito
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Felicia Grasso
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Stefania Mochi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Luisa Accardi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Maria Gabriella Donà
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Margherita Branca
- Unità Citoistopatologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Silvano Costa
- Dipartimento di Ginecologia e Ostetricia, Ospedale S. Orsola Malpighi, Bologna, Italy
| | - Luciano Mariani
- Clinica Ostetrica e Ginecologica, IFO, Istituto Regina Elena, Roma, Italy
| | - Alberto Agarossi
- Istituto Scienze Biomediche, Ospedale Luigi Sacco, Milano, Italy
| | - Marco Ciotti
- Laboratory of Clinical Microbiology and Virology, Policlinico of Tor Vergata University, Rome, Italy
| | - Kari Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, FIN-20521 Turku, Finland
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Fréquence, persistance et récidive des lésions à HPV du col utérin chez les patientes séropositives pour le VIH. ACTA ACUST UNITED AC 2008; 36:521-4. [DOI: 10.1016/j.gyobfe.2008.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/21/2008] [Indexed: 11/23/2022]
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Syrjänen K, Naud P, Derchain S, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Hammes LS, Matos J, Gontijo R, Sarian L, Bragança J, Arlindo FC, Maeda MYS, Lörincz A, Dores GB, Costa S, Syrjänen S. Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort. Int J STD AIDS 2008; 19:251-8. [DOI: 10.1258/ijsa.2007.007179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Drug abuse (addiction) has been listed among the risk factors for human papillomavirus (HPV) infections, but no case-control studies exist to rule out sexual behaviour and other potential confounders. The aim of this study is to evaluate the role of drug addiction as an independent predictor of HR-HPV infections and (cervical intraepithelial neoplasia) CIN2+ in an age-matched case-control (1:4) study nested within the prospective Latin American Screening (LAMS) study cohort. All 109 women in the LAMS cohort (n = 12,114) reporting drug abuse/addiction were matched with four controls (n = 436) of non-abusers strictly by age. Conditional logistic regression analysis was used to estimate the co-variates of drug abuse, and the whole series (n = 545) was analysed for predictors of HR-HPV and CIN2+ using univariate and multivariate regression models. Oncogenic HPV infections were significantly (P = 0.019) more prevalent among abusers (37.7%) than in controls (21.9%), but there was no difference in high-grade squamous intraepithelial lesions (P = 0.180) or CIN2+ lesions (P = 0.201). In multivariate conditional logistic regression, number of lifetime sexual partners (P = 0.0001), ever smokers (P = 0.0001), non-use of OCs (P = 0.013), ever having sexually transmitted diseases (STD) (P = 0.041) and no previous Pap smear (P = 0.027) were independent co-variates of drug addiction. Drug abuse was not an independent risk factor of high-risk (HR)-HPV infection, which was significantly predicted by (1) age below 30 years (P = 0.045), (2) more than five lifetime sexual partners (P = 0.046) and (3) being current smoker (P = 0.0001). In multivariate model, only HR-HPV infection was an independent risk factor of CIN2+ (P = 0.031), with adjusted OR = 11.33 (95% CI 1.25–102.50). These data indicate that drug addiction is not an independent risk factor of either HR-HPV infections or CIN2+, but the increased prevalence of HR-HPV infections is explained by the high-risk sexual behaviour and smoking habits of these women.
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Affiliation(s)
- K Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - P Naud
- Hospital de Clinicas de Porto Alegre
| | - S Derchain
- Universidade Estadual de Campinas, Campinas
| | | | - A Longatto-Filho
- Instituto Adolfo Lutz, Sao Paulo, Brazil
- University of Minho, Braga, Portugal
| | - S Tatti
- First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina
| | - M Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | - M Eržen
- SIZE Diagnostic Center, Ljubljana, Slovenia
| | | | - J Matos
- Hospital de Clinicas de Porto Alegre
| | - R Gontijo
- Universidade Estadual de Campinas, Campinas
| | - L Sarian
- Universidade Estadual de Campinas, Campinas
| | - J Bragança
- Universidade Estadual de Campinas, Campinas
| | | | - M Y S Maeda
- Instituto Adolfo Lutz, Sao Paulo, Brazil
- University of Minho, Braga, Portugal
| | | | | | - S Costa
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - S Syrjänen
- Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland
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Gonçalves MAG, Randi G, Arslan A, Villa LL, Burattini MN, Franceschi S, Donadi EA, Massad E. HPV type infection in different anogenital sites among HIV-positive Brazilian women. Infect Agent Cancer 2008; 3:5. [PMID: 18341690 PMCID: PMC2358880 DOI: 10.1186/1750-9378-3-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 03/14/2008] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence of human papillomavirus (HPV) types, and risk factors for HPV positivity across cervix, vagina and anus, we conducted a study among 138 women with human immunodeficiency virus (HIV). GOAL Compare the prevalence of different HPV types and the risk factors for HPV positivity in three sites. RESULTS The most frequently detected HPV types in all sites were, in decreasing order, HPV16, 53, 18, 61 and 81. Agreement between the cervix and vagina was good (kappa 0.60 - 0.80) for HPV16 and 53 and excellent (Kappa > 0.80) for HPV18 and 61. HPV positivity was inversely associated with age for all combinations including the anal site. CONCLUSION In HIV positive women, HPV18 is the most spread HPV type found in combinations of anal and genital sites. The relationship of anal to genital infection has implications for the development of anal malignancies. Thus, the efficacy of the current HPV vaccine may be considered not only for the cervix, but also for prevention of HPV18 anal infection among immunossuppressed individuals.
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Affiliation(s)
| | - Giorgia Randi
- Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Annie Arslan
- International Agency for Research on Cancer, Lyon, France
| | - Luisa L Villa
- Department of Virology, Ludwig Institute for Cancer Research, São Paulo, Brazil
| | - Marcelo N Burattini
- School of Medicine, Department of Pathology, University of São Paulo, São Paulo, Brazil
| | | | | | - Eduardo Massad
- School of Medicine, Department of Pathology, University of São Paulo, São Paulo, Brazil
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Abstract
Cervical cancer is not only the most frequently reported cancer among women, but also the most common female genital tract neoplasm in Taiwan. Early detection is effective, because the development, maintenance and progression of precursor lesions (cervical intraepithelial neoplasia [CIN]) evolve slowly into invasive cancer, typically over a period of more than 10 years. It is now recognized that human papillomavirus (HPV) infection is a necessary cause for over 99% of cervical cancer cases. Advances in the understanding of the causative role of HPV in the etiology of high-grade cervical lesions (CIN 2/3) and cervical cancer have led to the development, evaluation and recommendation of HPV-based technologies for cervical cancer prevention and control. The prevention of HPV infection before the onset of CIN is now possible with recently available prophylactic HPV vaccines, e.g. the quadrivalent Gardasil (Merck & Co., NJ, USA) and bivalent Cervarix (GlaxoSmithKline, London, UK). This review article provides an up-to-date summary of recent studies and available information concerning HPV and vaccination in cervical cancer.
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Affiliation(s)
- Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, National Taipei College of Nursing, Taipei, Taiwan.
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Hawes SE, Critchlow CW, Sow PS, Touré P, N'Doye I, Diop A, Kuypers JM, Kasse AA, Kiviat NB. Incident High-Grade Squamous Intraepithelial Lesions in Senegalese Women With and Without Human Immunodeficiency Virus Type 1 (HIV-1) and HIV-2. ACTA ACUST UNITED AC 2006; 98:100-9. [PMID: 16418512 DOI: 10.1093/jnci/djj010] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Women infected with human immunodeficiency virus type 1 (HIV-1) and -2 may be at higher risk of developing cervical cancer than uninfected women. We assessed the relationships among human papillomavirus (HPV) types and persistence, HIV-1 and/or HIV-2 infection, and the development of high-grade cervical squamous intraepithelial lesions (HSILs) in a prospective study. METHODS We studied 627 women with and without HIV-1 and/or HIV-2 infection and high-risk HPV infection in Senegal, West Africa, who were assessed every 4 months for HSIL and HPV DNA over a mean follow-up of 2.2 years. Cox regression modeling was used to assess risks associated with development of HSIL. RESULTS During follow-up, 71 (11%) of 627 women developed HSIL as detected by cytology. HIV-infected women with high-risk HPV types were at greatest risk for development of HSIL. In multivariable modeling, infection with oncogenic HPV types--both persistent (hazard ratio [HR] = 47.1, 95% confidence interval [CI] = 16.3 to 136) and transient (HR = 14.0, 95% CI = 3.7 to 54)--was strongly associated with HSIL risk. In univariate analyses, HIV-positive women infected with HIV-2 were less likely to develop HSIL (HR = 0.3, 95% CI = 0.1 to 0.9) than HIV-positive women infected with HIV-1. HIV-positive women with CD4+ cell counts between 200 and 500 cells per microliter (HR = 2.2, 95% CI = 0.8 to 6.3) or fewer than 200 cells per milliliter (HR = 5.5, 95% CI = 2.0 to 15.2) were at greater risk of HSIL than HIV-positive women with CD4 counts of more than 500 cells per milliliter. High plasma HIV RNA levels were associated with increased HSIL risk (HR for each order of magnitude increase in the level of plasma HIV RNA = 1.4, 95% CI = 1.1 to 1.7; P = .005). After adjustment for HPV types and persistence, however, HIV type, plasma HIV RNA level, and CD4 count were no longer statistically significantly associated with increased risk of HSIL. CONCLUSIONS HIV-1 and HIV-2 are associated with increased risk for development of HSIL. This risk appears to be associated primarily with increased HPV persistence that may result from immunosuppression related to HIV-1 and/or HIV-2 infection.
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Affiliation(s)
- Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA 98103, USA.
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Zhao FH, Forman MR, Belinson J, Shen YH, Graubard BI, Patel AC, Rong SD, Pretorius RG, Qiao YL. Risk factors for HPV infection and cervical cancer among unscreened women in a high-risk rural area of China. Int J Cancer 2006; 118:442-8. [PMID: 16080192 DOI: 10.1002/ijc.21327] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a prevalence rate of 23.6% human papillomavirus (HPV) infection with oncogenic subtypes and 2.4% cervical intraepithelial neoplasia (CIN) III and cervical cancer (CC) in rural middle-aged women in 2 counties with the highest CC mortality in Shanxi Province, China. We examined the association of risk factors to HPV infection and to CIN III and CC in 8,798 unscreened women aged 35-50 years. Multivariate odds ratios (OR) and 95% confidence intervals (CI) for each endpoint were obtained for risk factors after adjustment for covariates. The OR of oncogenic HPV were: 1.41 (95% CI = 1.25-1.60) and 1.42 (95% CI = 1.24-1.61) for the participant and her husband having multiple sexual partners, respectively; 1.67 (95% CI = 1.37-2.04), 1.15 (95% CI = 1.04-1.26), and 0.82 (95% CI = 0.72-0.94) for ever (vs. never) diagnosed with tuberculosis, cervical inflammation and vaginal trichomoniasis, respectively; while bathing in a public (v. private) facility had an OR of 1.23 (95% CI =1.11-1.35). Seasonal fluctuations in HPV infection, but not CC, appeared in Xiangyuan County, with OR of 1.23 (95% CI = 1.14-1.33) and 1.51 (95% CI = 1.35-1.67) in Spring and Winter compared to Summer, respectively. The OR of CIN III and CC in the HPV positives were: 2.03 (95% CI = 1.63-2.53) for ages > or =45 years (vs. <40); and 4.01 (95% CI = 1.46-11.0) for > or =3 (vs. no) home births. Public health interventions and control strategies for improving the reproductive health of women in these rural populations need to be developed to reduce risk of HPV and subsequent CC.
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Affiliation(s)
- Fang-Hui Zhao
- Department of Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Shew ML, Fortenberry JD. HPV infection in adolescents: natural history, complications, and indicators for viral typing. ACTA ACUST UNITED AC 2005; 16:168-74. [PMID: 16044390 DOI: 10.1053/j.spid.2005.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women. Prevalence rates are the highest for adolescents. Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments. Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection, including the use of HPV DNA detection tests, screening efforts for HPV-related precancerous and cancerous lesions, and clinical interventions and treatments, including both therapeutic and prophylactic vaccinations.
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Affiliation(s)
- Marcia L Shew
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis 46202, USA.
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Affiliation(s)
- V Sahasrabuddhe
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
PURPOSE OF REVIEW The role of the human papillomavirus in the pathogenesis has been the subject of many publications in the recent literature. The physical state of the human papillomavirus and the role of chromosomal aneuploidy has been reported. This review discusses the recent pathological mechanisms described in the genesis of human papillomavirus-related disease. RECENT FINDINGS The mere presence of the human papillomavirus is not sufficient for the development of neoplasia. Genetic and other co-factors seem to be necessary for the expression of the invasive phenotype. The expression of human papillomavirus 16 E6-E7 oncogenes results in chromosomal aneuploidy, favouring the integration of high-risk human papillomavirus genomes into cellular chromosomes. The integration of human papillomavirus 16 may not always be required for the progression to the invasive phenotype unlike human papillomavirus 18 DNA. Such integration sites are randomly distributed over the whole genome. The genetic susceptibility of codon 98 of the fragile histadine triad has been elucidated. SUMMARY Various molecular mechanisms of human papillomavirus-associated neoplasia are discussed. The interaction between HIV and human papillomavirus are complex and favour the persistence and progression of cervical disease. Future research should pave the way for therapeutic vaccine development.
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Affiliation(s)
- Manivasan Moodley
- Department of Gynaecology Oncology, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Congella, Durban, South Africa.
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Abstract
Although primary prevention of human papillomavirus (HPV) infections that are causally associated with invasive cervical cancer may be within our grasp, it is unlikely that these approaches will replace existing cervical cancer screening strategies for many years. Experts agree and data support periodic cytology screening for young-adult women using one of several technologies. Recent analyses of cost-effectiveness suggest that the addition of molecular HPV DNA testing for women aged over 30 years may allow the screening interval to be lengthened to 3 years for most women. Women at high risk for HPV infection and its associated cellular atypias warrant closer monitoring and follow-up. These patients would include organ transplant recipients, women exposed to diethylstilbestrol (DES), and HIV-infected women.
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Affiliation(s)
- Dorothy J Wiley
- Division of Primary Care, School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095-6919, USA.
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