Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer

Abstract

Objective: Recent studies reported lower human papillomavirus 16 (HPV16) prevalence in cervical precancer among African American than Caucasian women in the general population. We assessed this relationship in women with HIV. Design: Women living with or at risk for HIV in the Women’s Interagency HIV Study were followed semi-annually with Pap tests, colposcopy/histology (if indicated), and collection of cervicovaginal lavage samples for HPV testing by PCR. Racial and ethnic groups were defined using genomic Ancestry Informative Markers (AIMs). Results: Among 175 cases of cervical intraepithelial neoplasia 3 or worse (CIN-3+), 154 were diagnosed in women with HIV. African American (27%) and Hispanic (37%) cases were significantly less likely than Caucasian (62%) women to test positive for HPV16 (p=0.01). In multivariate logistic regression models, these associations remained significant for African Americans (odds ratio=0.13; 95% confidence interval 0.04–0.44; p=0.001) but not Hispanics, after controlling for HIV status, CD4 count, history of AIDS, age, smoking, and sexual behavior. Limiting the analysis to women with HIV did not change the findings. Conclusion: HPV16 prevalence is lower in African American compared to Caucasian women with HIV and cervical precancer, independent of immune status. Future studies to determine why these racial differences exist are warranted, and whether there are similar associations between race and invasive cervical cancer in women with HIV. Further, HPV types not covered by quadrivalent and bivalent vaccines may play an especially important role in cervical precancer among HIV-positive African American women, a possible advantage to using nonavalent HPV vaccine in this population.

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

“…This is consistent with results from earlier meta-analyses that have found women from SSA to have the lowest proportion globally of HPV16 in all grades of cervical lesions, regardless of HIV status (8,9,26,27). Meanwhile, U.S. studies have found lower HPV16 prevalence in CIN3þ in African American women compared with Caucasian women, regardless of HIV status and independent of immune status (28,29).…”

Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review

“…Considering race, in the United States, the incidence of HIV+ women diagnosed with cervical intraepithelial neoplasia grade 3 or higher was higher in African-Americans than Caucasians, with a ratio of 5:1. In the United States, the prevalent strains of hrHPV among HIV+ African-American women diagnosed with cervical cancer were HPV-16 (26.8%), HPV-53 (20.5%), HPV-35 (15.2%) and HPV-52/58 (14.3%) [ 14 ]. There is a paucity of data on the relationship between the types of HPV observed in African-American women and African women.…”

Reasons for non-attendance to cervical cancer screening and acceptability of HPV self-sampling among Bruneian women: A cross-sectional study

“…Other studies have detected a significant percentage of non-16/18 hr-HPV genotypes, suggesting the presence of region-specific heterogeneity in the HPV genotype distribution [ 35 – 39 ]. Also, variation in HPV distribution among different ethnic groups has been reported in an American study [ 40 ]. Our finding has potential implication on Brunei’s national school-based HPV vaccination program [ 41 ] which currently provides vaccines which do not confer protection against non-16/18 genotypes.…”