Characteristics of HPV infection over time in European women who are HIV‐1 positive

Abstract

Objective The objectives of the study were to investigate high-risk human papillomavirus (HR-HPV) infection and type distribution in women infected with HIV-1, and to determine the relevance of HR-HPV positivity and persistence/loss to the development of high-grade cervical disease.Design A total of 518 European women infected with HIV attending for routine gynaecological care consented to 6-monthly follow-up visits over 3 years, with surveillance of cytology, colposcopy and histopathology, where relevant, and longer follow-up, where possible.Setting European women infected with HIV attending for routine gynaecological care.Population or sample 518 European women infected with HIV attending for gynaecological care in 6 hospital-based European centres -Dublin, Edinburgh, London, Milan, Paris, and Warsaw.Methods Cervical screening was achieved by liquid-based cytology (LBC) of brush samples in PreservCytÒ medium. The HPV testing of residual samples was performed by Hybrid-Capture II, with genotyping of positives using the HPV Line Blot Assay. Histology results were accessed where available.Main outcome measures Description of high risk human papillomavirus (HR-HPV) infection and type distribution in HIV-1 infected women. ResultsThe estimated prevalence at baseline of any HR-HPV type was 49.5% (46.3-52.8%): 10.2% for HPV 16 and 4.3% for HPV 18. The prevalence increased with increasing immunosuppression. Multiple infections were detected in 26.8%. HR-HPV genotypes were detected in 34.9% of cases with normal cytology, in 77.2% of cases with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) and in 90.8% of cases with high-grade SIL (HSIL). The prevalence of HPV 16 in HSIL was 38.5%, with the three most common types thereafter having prevalence rates of 19.2% (HPV 58), 19.2% (HPV 53) and 16.6% (HPV 52). The overall persistence of any high-risk type was 55.8%. We found that 6 months persistence of HPV 16 occurred in 24 women. Seven cases of high-grade cervical disease developed, and all were associated with initial/persistent HR-HPV positivity.Conclusions A wide diversity of HPV types was evident, and multiple infections were common. Detection or persistence of any HR-HPV was associated with a very low incidence of subsequent high-grade disease.

Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

“…Compared with the above, a multicentre Catalan study revealed inadequate rates of cervical cancer screening with only 50% of HIV positive women reporting that they had annual screening [15]. It is worth mentioning that in a prospective study of HPV infection among HIV positive women from European countries with a study population of over IDU -injected drug users; CI -confidence interval; OR -odds ratio 1100 women, only 55.5% provided a second sample after 6 or more months [3]. In our study of women receiving routine care, over half the women had two or more cytological tests performed, which is still an unsatisfactory result.…”

“…HIV-positive women are at increased risk of acquiring HPV and of the HPV infection and persistency of HPV infection, especially with high-risk HPV [2,3]. As a consequence, this group of women presents a five to six times higher risk of cervical cancer [4,5].…”

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

“…Therefore, we chose to match WLWH and WGP on age and prior cytology/histology results. The overall hrHPV prevalence in WLWH of 26.4 % was lower than the hrHPV prevalence found in the European MACH-1 collaborative group of WLWH with a prevalence close to 50 % [15], however participants in the MACH study were younger (median age: 35 versus 42.5 years), less likely to be on HAART (69.7 % versus 94.9 %) and a different assay (Hybrid Capture II) was used for HPV detection. On a global scale the highest prevalence of HPV in WGP with normal cytological findings is found in Africa (24 %) [14].…”

“…The hrHPV genotype distribution in Denmark [11, 12] and worldwide is well described in WGP and globally HPV16, 18, 52, 31, and 58 predominate [10, 13, 14]. Most studies suggest a different HPV genotype distribution in WLWH with increased frequency of non-16/18 HPV genotypes, which are not targeted by the 2-and 4-valent HPV vaccines [8, 15, 16]. …”

British HIV Association Guidelines on the Use of Vaccines in HIV‐Positive Adults 2015

“…Men and women with HIV infection show an increased risk and rate of HPV acquisition and persistence, frequent carriage of multiple HPV types, and an increased risk of HPV‐related disease including rapidly progressive malignancies . HPV carriage rates and overall disease risk increase at low CD4 cell counts.…”