Prevalence of human papillomavirus in women with invasive cervical carcinoma by HIV status in Kenya and South Africa

Abstract

Data on the prevalence of human papillomavirus (HPV) types in cervical carcinoma in women with HIV are scarce but are essential to elucidate the influence of immunity on the carcinogenicity of different HPV types, and the potential impact of prophylactic HPV vaccines in populations with high HIV prevalence. We conducted a multicentre case-case study in Kenya and South Africa. During 2007-2009, frozen tissue biopsies from women with cervical carcinoma were tested for HPV DNA using GP51/61-PCR assay. One hundred and six HIV-positive (mean age 40.8 years) and 129 HIV-negative women (mean age 45.7) with squamous cell carcinoma were included. Among HIV-positive women, the mean CD4 count was 334 cells/lL and 48.1% were on combined antiretroviral therapy. HIV-positive women had many more multiple HPV infections (21.6% of HPV-positive carcinomas) compared with HIV-negative women (3.3%) (p < 0.001) and the proportion of multiple infections was inversely related to CD4 level. An excess of HPV18 of borderline statistical significance was found in HIV-positive compared with HIVnegative cases (Prevalence ratio (PR) 5 1.9, 95% confidence interval (CI): 1.0-3.7, adjusted for study centre, age and multiplicity of infection). HPV16 and/or 18 prevalence combined, however, was similar in HIV-positive (66.7%) and HIVnegative cases (69.1%) (PR 5 1.0, 95% CI: 0.9-1.2). No significant difference was found for other HPV types. Our data suggest that current prophylactic HPV vaccines against HPV16 and 18 may prevent similar proportions of cervical SCC in HIVpositive as in HIV-negative women provided that vaccine-related protection is sustained after HIV infection. Infection with high-risk (HR) human papillomavirus (HPV)is a necessary cause for invasive cervical carcinoma. Worldwide HPV16 and 18 are found in 57% and 16% of cervical carcinomas, respectively, according to the findings of a recent meta-analysis 1 and are targeted by the current prophylactic HPV vaccines for cervical carcinoma prevention. HIV-positive women are at increased risk for HPV infection and progression to cervical intraepithelial neoplasia grade 3 (CIN3). 2Linkage studies between HIV/AIDS and cancer registries have shown a 2-to 22-fold increased invasive cervical carcinoma incidence in HIV-positive women compared with the general female population from the same area, depending upon the life expectancy of HIV-positive women and the coverage and quality of cervical cancer screening in different countries. 3,4 HPV16 infection and HPV16-associated precancerous lesions were reported to be less dependent on a woman's immune status compared with other HR HPV types.5 Indeed, a meta-analysis of HPV prevalence in HIV-positive women worldwide showed a relative underrepresentation of HPV16 and overrepresentation of the other HR HPV types in HIVpositive compared with HIV-negative women with or without cervical abnormalities. 6 The lower prevalence of HPV16 in CIN2/3 (the endpoint lesions used in the evaluation of HPV vaccine efficacy) raised the fear that vaccination may preven...

Genotype Distribution and Behavioral Risk Factor Analysis of Human Papillomavirus Infection in Uyghur Women

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