Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

Abstract

ObjectiveWomen living with HIV (WLHIV) face disproportionately higher risks of acquiring human papillomavirus (HPV) compared with HIV negative counterparts. We aimed to investigate the prevalence of HPV in WLHIV in Chinese hospital setting and identify associated factors to the progression of late-stage cervical intraepithelial neoplasia (CIN2+) in this population.MethodThis retrospective study collected data from 183 WLHIV on antiretroviral treatment (ART), based on reproductive health questionnaires. Gynaecological examination results including serum (for HIV viral load, CD4 T-cell count, hepatitis B infections, syphilis) and vaginal swabs for common bacterial sexually transmitted infections (STIs). Multivariate-logistic regression was applied to analyze the contributing factors to CIN2+.ResultsHIV coinfection with other Sexually Transmitted Infections (STIs) were observed in 99 participants (54.1%, (99/183)). HPV (43.7% (80/183)) was the most prevalent STI. The three most prevalent HPV subtypes were all high-risk HPV (HR-HPV), including HPV52 (33.8% (27/80)), HPV58 (21.3% (17/80)) and HPV33 (13.75% (11/80)). About a third (37.5%, 30/80) of women with HPV had HR-HPV. Multiple HPV coinfections were common in HIV-HPV coinfected women (41.3%, 33/80). Cytological examinations revealed that 77.5% (62/80) HPV+ women had detectable cervical lesions. In comparison, only 4.9% (5/103) HPV negative womenwith Atypia and 1.0% (1/103) with CIN1 were diagnosed. Multivariate logistic regression revealed that HPV16 (OR=19.04, 2.53 to 122.92; p=0.004) and HPV18 (OR=11.54, 1.45 to 91.64; p=0.021) infections were significantly associated with CIN2+ in HIV-HPV coinfected women.ConclusionA high prevalence of HPV was found in women on ART. HPV16/18 infection are strong associated factors to CIN2+ in HIV-HPV coinfected women.

Prevalence of HPV infection and cervical intraepithelial lesions in HIV positive and negative women in the city of Florianopolis

“…On the other hand, of the 11 HIV-positive women, 7 (63.6%) presented changes. Similarly to this finding, the study by Wang et al showed, through cytological examinations, that 77.5% of HIV-positive women infected with HPV had detectable cervical lesions in comparison to only 4.9% of the HIV-negative women infected with HPV (20) .…”

Increased CD4+ T cell count is associated with lower anal human papillomavirus prevalence among HIV-positive male cohort in Taizhou, China: a cross-sectional study

“…Most studies analyzing the impact of cART on HPV infection reported beneficial effect [ 19 , 20 , 33 – 35 ]. A meta-analysis concluded that cART is associated with decreased prevalence of anal HR-HPV infection in HIV population [ 19 ].…”

HPV co‐infections with other pathogens in cancer development: A comprehensive review

“…159,161 For example, the most prevalent HPV types were HPV-56 and HPV-16 in Brazilian patients, 136 and HPV-52 and HPV-58 in Chinese patients. 162 Moreover, HPV genotyping from cervical samples of HIV-positive patients in São Paulo showed that HPV-56 was the predominant genotype followed by HPV- were also observed at lower rates in these samples, respectively. 136 However, immunodeficiency can likely contribute to an increased susceptibility to other types of HPVs in HIV-infected patients.…”

“…However, other genotypes (e.g., HPV types 18, 45, and 35) were also observed among cervical cancer specimens 158–160 that can be linked to HIV 159,161 . For example, the most prevalent HPV types were HPV‐56 and HPV‐16 in Brazilian patients, 136 and HPV‐52 and HPV‐58 in Chinese patients 162 . Moreover, HPV genotyping from cervical samples of HIV‐positive patients in São Paulo showed that HPV‐56 was the predominant genotype followed by HPV‐16, HPV‐81, HPV‐62, and HPV‐83.…”