Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa

Abstract

Objective: To examine the association between CD4 counts, HPV infection and the risk of cervical neoplasia among HIV-seropositive women.

Methods: 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.

Results: 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.

Conclusion: 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.

Fig. 1

Prevalence of HPV types by cervical status among 191 HIV-infected women in Johannesburg, South Africa (Normal = 90 women, AGUS/ASCUS = 14 women, LSIL = 51 women and HSIL = 36 women)

Fig. 2

Prevalence of HPV types by CD4 count levels among 191 HIV-infected women in Johannesburg, South Africa (CD4 < 200/mm³: 87 women, CD4 200–500/mm³: 87 women, CD4 > 500/mm³: 17 women)