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Observational Study
. 2018 Aug 1;67(4):606-613.
doi: 10.1093/cid/ciy144.

Risk Factors for Human Papillomavirus Infection and Abnormal Cervical Cytology Among Perinatally Human Immunodeficiency Virus-Infected and Uninfected Asian Youth

Annette H Sohn  1 , Stephen J Kerr  2   3 , Rawiwan Hansudewechakul  4 , Sivaporn Gatechompol  2 , Kulkanya Chokephaibulkit  5 , Hanh Le Dung Dang  6 , Dan Ngoc Hanh Tran  7 , Jullapong Achalapong  4 , Nipat Teeratakulpisarn  2 , Amphan Chalermchockcharoenkit  5 , Manopchai Thamkhantho  5 , Tippawan Pankam  8 , Thida Singtoroj  1 , Wichai Termrungruanglert  9 , Surasith Chaithongwongwatthana  9 , Nittaya Phanuphak  8 ; HPV in Adolescents Study
Collaborators, Affiliations
Observational Study

Risk Factors for Human Papillomavirus Infection and Abnormal Cervical Cytology Among Perinatally Human Immunodeficiency Virus-Infected and Uninfected Asian Youth

Annette H Sohn et al. Clin Infect Dis. .

Abstract

Background: Infection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)-infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency.

Methods: PHIV and HU females aged 12-24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses.

Results: Ninety-three PHIV and 99 HU adolescents (median age 19 [18-20] years) were enrolled (June 2013-July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392-808) cells/mm3, and 62% had a viral load <40 copies/mL. Across anogenital compartments, PHIV had higher rates of any HPV detected (80% vs 60%; P = .003) and any HR-HPV (60% vs 43%, P = .02). Higher proportions of PHIV had abnormal Pap smears (eg, atypical squamous cells of unknown significance [ASC-US], 12% vs 14%; low-grade squamous intraepithelial neoplastic lesions, 19% vs 1%). After adjusting for ever being pregnant and asymptomatic sexually transmitted infections (STI) at enrollment, PHIV were more likely to have HR-HPV than HU (odds ratio, 2.02; 95% confidence interval, 1.09-3.77; P = .03).

Conclusions: Perinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.

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Figures

Figure 1.
Figure 1.
Prevalence of individual high-risk human papillomavirus subtypes by anatomical site. Abbreviations: HIV, human immunodeficiency virus; HIV-neg, HIV uninfected; HPV, human papillomavirus; PHIV, perinatally HIV infected.
Figure 2.
Figure 2.
Cervical cytology results. P for difference between groups <0.001. Abbreviations: ASC-H, atypical squamous cells, cannot exclude HSIL; ASC-US, atypical squamous cells of unknown significance; HIV, human immunodeficiency virus; HIV-neg, HIV uninfected; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; PHIV, perinatally HIV infected.
See this image and copyright information in PMC

References

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