Multitype Infections With Human Papillomavirus: Impact of Human Immunodeficiency Virus Coinfection

Abstract

Background Human immunodeficiency virus (HIV) infection predisposes women to genital coinfection with human papillomaviruses. Concurrent infection with multiple HPV types has been documented, but its frequency, correlates, and impact on development of precancer are poorly defined in HIV seropositive women. Methods HIV seropositive women and seronegative comparison women were enrolled in a cohort study and followed every six months 1994–2006. Cervicovaginal lavage samples were tested for HPV types using polymerase chain reaction amplification with MY09/MY11 consensus primers followed by hybridization with consensus and HPV type-specific probes. Analyses were performed using generalized estimating equations. Results Multitype HPV infections were found in 594/2543 (23%) HIV seropositive women and 49/895 seronegative women (5%, P < 0.0001). Compared to HPV uninfected women, those with multiple concurrent HPV infections were more likely to be younger, nonwhite, and current smokers, with lower CD4 counts and HIV RNA levels. The average proportion of women with multitype HPV infections across visits was 21% in HIV seropositive women and 3% in seronegative women (P <0.0001). Compared to infection with one oncogenic HPV type, multitype concurrent infection with at least one other HPV type at baseline did not measurably increase the risk of ever having CIN3+ detected during follow-up (O.R. 0.80, 95% C.I. 0.32, 2.03, P = 0.65). Conclusion Concurrent multitype HPV infection is common in HIV seropositive women and frequency rises as CD4 count declines, but multitype infection does not increase precancer risk.

HPV Types in Cervical Precancer by HIV Status and Birth Region: A Population-Based Register Study

“…We did not find as high rates of multiple HPV infection in WLWH with CIN3 as have been seen in earlier studies (32)(33)(34). One explanation may be that our study was based on biopsies rather than cell samples, and testing for HPV from biopsies is known to reduce the prevalence of multiple infections (8,9,27,35).…”

“…The clinical importance of multiple infections is unclear as prospective evidence on this issue is limited (36). A U.S. study with long-term follow-up did not find multiple HPV infection associated with an increase of CIN3, adenocarcinoma in situ or ICC (34). In another study, including only HIVnegative women, coinfection with both low-and high-risk HPV was even associated with a reduced risk of future invasive disease and slower progression to ICC (37).…”

Human Immunodeficiency Virus Infection Promotes Human Papillomavirus-Mediated Anal Squamous Carcinogenesis: An Immunologic and Pathobiologic Review

“…First, as patients with HIV have gained access to improved medical management and longer life spans, the incidence of HIV-associated malignancies has increased [38, 42-46]. Furthermore, studies have found higher frequencies of coinfection with multiple strains of HPV in HIV-infected patients at oral and anogenital sites, compared to those without HIV [53-56]. As some lineages and sub-lineages of HPV display biological characteristics associated with persistent infections and evolution to cancer development, patients with HIV with a high HPV strain diversity may increase the risk of carcinogenesis [53-56].…”

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“…Immunological mechanisms can also determine multiple infection prevalence. The prevalence of mixed infections among immunosuppressed women infected with HIV is still high (Massad et al, 2016). Women with HPV Co-infection between the ages of 30 to 40 account for only 11,32%.…”