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Human Papillomavirus Infection and Cervical Disease in Human Immunodeficiency Virus-1–Infected Women

From the ¹Department Obstetrics and Gynaecology, ²University of Cape Town, and The Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; ³National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; ⁴Department of Medicine, University of Cape Town, Cape Town, South Africa; ⁵Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.

OBJECTIVE: To report on the natural history of high-risk human papillomavirus (HPV) infection and cervical disease in human immunodeficiency virus (HIV)-1–infected women living in Cape Town, South Africa.

METHODS: This was a prospective study of 400 untreated, HIV-1–infected women who underwent high-risk HPV DNA testing, cytology, colposcopy, histology, and CD4 count testing every 6 months for 36 months. Human immunodeficiency virus viral loads and HPV type distribution were determined at entry and after 18 months.

RESULTS: Sixty-eight percent of the women were high-risk HPV DNA positive at entry, 35% had a cytologic diagnosis of low-grade squamous intraepithelial lesion (LSIL), and 13% had high-grade squamous intraepithelial lesion (HSIL). There were no cancers. Abnormal cytology and high-risk HPV positivity were strongly correlated with low CD4 counts and high HIV viral loads. The most prevalent types of HPV were HPV-16, -52, -53, -35, and -18. Incident high-risk HPV infection occurred in 22%, and of those infected with high-risk HPV, 94% of infections persisted over an 18-month period, and 6% cleared their infections. Cytologic progression to SIL from normal/atypical squamous cells of undetermined significance cytology occurred in 17% of cases, but only 4% of cases of LSIL progressed to HSIL.

CONCLUSION: There is a high level of high-risk HPV infection in HIV-1 infected women, but progression to HSIL over 36 months occurred in the minority of cases. We recommend an initial colposcopy for an abnormal test, and if no high-grade lesion is identified, triennial screening would be appropriate. Human papillomavirus type 16 was the commonest, and HPV-18 was the fifth commonest, suggesting that vaccination against these two types would have a significant effect.

LEVEL OF EVIDENCE: II

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				Cervical Disease Is Common Among HPV-Positive Women with HIV Journal Watch (General), June 26, 2008; 2008(626): 6 - 6. [Full Text]