Human Papillomavirus Infection in HIV-1 Infected Women in Catalonia (Spain): Implications for Prevention of Cervical Cancer

Abstract

BackgroundHigh-risk human Papillomavirus infection is a necessary factor for cervical squamous intraepithelial lesions and invasive cervical cancer. In HIV-1-infected women, HPV infection is more prevalent and a higher risk of cervical cancer has been identified. We aimed to calculate the prevalence of infection by HR-HPV, determine the factors associated with this infection and abnormal cytology findings and to describe the history of cervical cancer screening in HIV-1-infected women.MethodsWe enrolled 479 HIV-1–infected women from the PISCIS cohort. Each patient underwent a gynecological check-up, PAP smear, HPV AND Hybrid capture, HPV genotyping, and colposcopy and biopsy, if necessary. We applied questionnaires to obtain information on sociodemographic, behavioral, clinical, and cervical screening variables. We present a cross-sectional analysis.ResultsMedian age was 42 years. The prevalence of HR-HPV infection was 33.2% and that of high-grade squamous intraepithelial lesions (HSIL) was 3.8%. The most common genotypes were 16(23%), 53(20.3%), and 52(16.2%). The factor associated with HR-HPV infection was age <30 years (odds ratio[OR],2.5; 95%confidence interval[CI],1.1–5.6). The factors associated with the presence of HSIL or low-grade squamous intraepithelial lesions (LSIL) were CD4T-lymphocyte count <200cells/mm3 versus >500cells/mm3 (OR,8.4; 95%CI,3.7–19.2), HIV-1 viral load >10,000copies/mL versus <400copies/mL (OR,2.1; 95%CI,1.0–4.4), and use of oral contraceptives (OR,2.0; 95%CI,1.0–3.9). Sixty percent of HIV-1–infected women had had one Pap smear within the last 2 years.ConclusionsThe high prevalence of HPV infection and cervical lesions in the HIV-1–infected population in Catalonia, as well as the low coverage and frequency of screening in this group, means that better preventive efforts are necessary and should include vaccination against HPV, better accessibility to screening programs, training of health care professionals, and specific health education for HIV-1–infected women.

Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population

“…The screening coverage found in the present study is considerably lower than what have been published in previous studies reporting a coverage to the annual ICC HIV screening program between 51% and 81% [13,14,16,30]. These studies are based on self-reported data, and the difference might reflect that women tend to over-report their participation in cervical screening in a given timeframe and therefore these rates are likely upper-end estimates [31].…”

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

“…In general, throughout the study period, the authors analysed different time intervals, with the range of HIV-positive women who followed the HIV cervical screening guidelines being from 29% to 46%. 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].…”

“…However, data coming from observational studies in Europe, although scarce, shows that barriers to cervical cancer screening still exist, from both the patient's and the health system's perspectives [14,15,20]. It is important to note that according to a recently published EuroSIDA study of a pan-European longitudinal observational cohort, cancer screening has a low coverage in both Eastern and non-Eastern European countries [21].…”

Human papillomavirus infection in oral fluids of HIV-1-positive men:prevalence and risk factors

“…In HIV-infected subjects, oral HPV infection is more aggressive and more highly prevalent compared with a healthy population161922. A comparative study including HIV-infected patients and healthy subjects foundthat 25.3% of HIV patients had an HPV infection in the oral tractcompared with 7.6% of healthy subjects23.…”