Risk factors for cervical HPV infection and genotypes distribution in HIV-infected South Brazilian women

Abstract

Background: Human Papillomavirus (HPV) infection is particularly burdensome for women infected with human immunodeficiency virus (HIV), which increases their risk of developing cervical lesions and cancer (CC). We conducted a molecular study of the distribution of cervical HPV genotypes and the risk factors for this infection in HIV-infected Brazilian women.

Findings: Cervical and endocervical samples for Papanicolaou screening and HPV detection were collected from 178 HIV-infected women using highly active antiretroviral therapy (HAART) of Maringá city/Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding to HIV infection from medical records. HPV was detected by polymerase chain reaction (PCR), and genotyping using PCR-restriction fragment length polymorphism analysis. HIV infection was well controlled, but women with a current CD4+ T lymphocyte count between 200-350 cells/mm3 (37.6%) had a two-fold greater risk of HPV infection than those with > 350 cells/mm3 (26.4%). HPV was associated with parity ≥3, hormonal contraceptive use and current smoker. HPV infection occurred with high frequency (46.6%) but a low frequency of cervical abnormalities was detected (7.30%), mainly low-grade squamous intraephitelial cervical lesions (LSIL) (84.6%). A high frequency of multiple HPV infections was detected (23.0%), and the most frequent HPV genotype was HPV-72 (6.7%), followed by -16, -31 and -51 (6.14% each).

Conclusions: We showed that HAART use does not protect HIV-infected women from HPV, but appear to exert some protection against cervical lesions development. This study provides other important information about risk factors and cervical HPV in HIV-infected women, which can contribute to planning protocols.

Figure 1

Electrophoretic analysis of HPV genotyping by PCR-restriction fragment length polymorphism analysis (PCR-RFLP) using HpyCH4V in 8% polyacrylamide gel stained with ethidium bromide. Sample A1, genotype −31 (HR) in single HPV infection (216, 108, 94 base pairs-pb); A2, genotype −56 (HR) in single HPV infection (244, 121 pb); A3, genotypes −13 (LR), -16 and −58 (HR) in multiple HPV infection (244, 216, 191, 103, 99, 91 e 89 pb); A4, genotype −51 (HR) in single HPV infection (171, 147, 137 pb); A5, genotypes −16 (HR) and −61 (LR) on double HPV infection (216, 191, 171, 147, 137). M, molecular weight marker (25 base pairs).