Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa
Firnhaber, C.; Van Le, H.; Pettifor, A.; Schulze, D.; Michelow, P.; Sanne, I.M.; Lewis, D.A.; Williamson, A-Lise.; Allan, B.; Williams, S.; Rinas, A.; Levin, S.; Smith, J.S.
Cancer Causes and Control Ccc 21(3): 433-443
2010
ISSN/ISBN: 0957-5243 PMID: 19949850 DOI: 10.1007/s10552-009-9475-zDocument Number: 214921
To examine the association between CD4 counts, HPV infection and the risk of cervical neoplasia among HIV-seropositive women. A cross-sectional observational study was conducted among 1,010 HIV-seropositive women using cytology-based Pap smears. HPV DNA testing using Linear Array genotyping assay (Roche) was carried out in a subset of 191 patients. Multivariable-adjusted prevalence ratios (mPR) and 95% confidence intervals (CIs) were estimated with log-binomial regression. Among 1,010 HIV-seropositive women, the prevalence of AGC/ASCUS, LSIL and HSIL or greater was 8.3, 23.5 and 18.0%, respectively. The risk of cervical lesions was higher with CD4 < 200 cells/mm(3) vs. CD4 levels > 500/mm(3). HPV types 16 (41.7%) and HPV 56 (22.2%) were the most common types in HSIL cases. Women with CD4 levels < 200/mm(3) had a higher prevalence of HPV types 16 (p < 0.01) and 66 (p = 0.04). No statistical relationship between cervical lesions and HAART use was found. The burden of HPV infection and HSIL was high and correlated with HIV-induced immunosuppression. HPV 16 was the most common type in HSIL and increased in prevalence with greater immune suppression. Prophylactic HPV 16 vaccination could prevent approximately 40% of HSIL cases. Strengthening screening programs is imperative in this population.
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