Predictors of HPV incidence and clearance in a cohort of Brazilian HIV-infected women

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.

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

“…Much of the data on HPV prevalence in women with HIV has come from large observational cohorts. In a prospective cohort of 333 Brazilian women with HIV observed over 2 years, the prevalence of cervical HPV-16 and HPV-18 were 5.1% and 3.9% respectively, with the hrHPV incidence at 12 months of only 3.7% and a clearance rate of 41.7% [40] . Variables associated with HPV incidence in this cohort were nulliparity, oral contraceptive use, and detectable HIV-1 RNA viral load.…”

Exploring lay public and dental professional knowledge around HPV transmission via oral sex and oral cancer development

“…From more than 100 different strains of HPV, subtypes 16 and 18 have been associated with the majority of HPV-positive head and neck cancers [7, 17–19]. These two subtypes are also present in most ano-genital and cervical malignancies [11, 15, 20], which might be explained, in part, by changes in sexual habits in recent decades.…”

“…Nonetheless, individuals with frequent oral sex encounters, a greater number of different sexual partners, and earlier sexual experiences seem to be at a higher risk [29]1 for oropharyngeal cancer development [19, 24]; gender and sexual identity also have a heavy influence on sexual practices [30]. Given the high costs of cancer treatment and the often negative psychosocial impact of such treatments when they involve disfigurement, awareness and prevention are key.…”

Protease inhibitor effects on prevalence of bacterial vaginosis and human papillomavirus‐related lesions

“…Persistence of high‐risk HPV infection is necessary for the development of cervical cancer and precursor lesions. Adherence to ART and viral suppression seem to be the most important factors in the decrease of HPV infection …”