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. 2023 Apr 26;227(9):1088-1096.
doi: 10.1093/infdis/jiac428.

Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance Among Women in Senegal, West Africa

Zhuochen Li  1 , Rachel L Winer  1 , Selly Ba  2 , Marie Pierre Sy  2 , John Lin  1   3 , Qinghua Feng  3 , Geoffrey S Gottlieb  4   5 , Papa Salif Sow  2 , Nancy B Kiviat  3 , Stephen E Hawes  1   5   6
Affiliations

Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance Among Women in Senegal, West Africa

Zhuochen Li et al. J Infect Dis. .

Abstract

Background: Persistent infection with high-risk human papillomavirus (HPV) is associated with development of invasive cervical cancer.

Methods: Longitudinal data was collected from 174 Senegalese women. We employed marginal Cox proportional hazards models to examine the effect of human immunodeficiency virus (HIV) status (HIV positive vs HIV negative) and HIV type (HIV-1 vs HIV-2 vs dual HIV-1/HIV-2) on clearance of type-specific HPV infection. Analyses were stratified by incident versus prevalent HPV infection.

Results: Incident HPV infections in HIV-positive women were less likely to clear than those in HIV-negative women (adjusted hazard ratio [HR] = 0.60; 95% confidence interval [CI], .38-.94). Among HIV-positive women, HIV-2-infected women and HIV-1/2 dually infected women were more likely to clear HPV incident infections than HIV-1-infected women (HR = 1.66; 95% CI, .95-2.92 and HR = 2.17; 95% CI, 1.12-4.22, respectively). Incident HPV infections in HIV-positive women with CD4 cell count ≤500 cells/μL were less likely to clear than those in HIV-positive women with CD4 cell count >500 cells/μL (HR = 0.65; 95% CI, .42-1.01). No significant associations were observed for prevalent HPV infections.

Conclusions: HIV infection reduced the likelihood of clearance of incident HPV infection. Furthermore, among HIV-positive women, low CD4 cell count and dual HIV infection were each associated with reduced likelihood of clearance.

Keywords: HIV; HIV-2; HPV; clearance; human immunodeficiency virus; human papillomavirus; women.

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Conflict of interest statement

Potential conflicts of interest. G. S. G. has received research grants and research support from the US National Institutes of Health, the University of Washington, the Bill and Melinda Gates Foundation, Gilead Sciences, Alere Technologies, Merck & Co., Janssen Pharmaceutica, Cerus Corporation, ViiV Healthcare, Bristol-Myers Squibb, Roche Molecular Systems, Abbott Molecular Diagnostics, and THERA Technologies/TaiMed Biologics, Inc. S. E. H. has received research grants and research support from the US National Institutes of Health, the University of Washington, and the Bill and Melinda Gates Foundation. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Cumulative probability of clearing human papillomavirus (HPV) infection by human immunodeficiency virus (HIV) status. Data are for 174 Senegalese women with HPV infections, in 2006–2010. Cumulative probability of clearing HPV was estimated by Kaplan-Meier methods. A, In total, 275 type-specific incident HPV infections were analyzed, including 68 from HIV-negative women and 207 from HIV-positive women. A total of 320 person-years were at risk of clearance. We observed 192 HPV infections were cleared, including 52 from HIV-negative women and 140 from HIV-positive women. The result of log-rank test indicated that the distribution of time until clearance of incident HPV infection is different for women with and without HIV infection at the .05 significance level (P = .02). B, In total, 389 type-specific prevalent HPV infections were analyzed, including 115 from HIV-negative women and 274 from HIV-positive women. A total of 547 person-years were at risk of clearance. We observed 196 HPV infections were cleared, including 70 from HIV-negative women and 126 from HIV-positive women. The result of log-rank test indicated that the distribution of time until clearance of prevalent HPV infection is the same for women with and without HIV infection at the .05 significance level (P = .3).
Figure 2.
Figure 2.
Cumulative probability of clearing human papillomavirus (HPV) infection by human immunodeficiency virus (HIV) type. Data are for 99 HIV-positive Senegalese women with HPV infections, in 2006–2010. Cumulative probability of clearing HPV was estimated by Kaplan-Meier methods. A, In total, 207 type-specific incident HPV infections were analyzed, including 174 from HIV-1–infected women, 22 from HIV-2–infected women, and 11 from HIV-1/2 dually infected women. A total of 249 person-years were at risk of clearance. We observed 140 HPV infections were cleared, including 115 from HIV-1–infected women, 17 from HIV-2–infected women, and 8 from HIV-1/2 dually infected women. The result of log-rank test indicated that the distribution of time until clearance of incident HPV infection is the same for women infected by different HIV types at the .05 significance level (P = .1). B, In total, 274 type-specific prevalent HPV infections were analyzed, including 221 from HIV-1–infected women, 32 from HIV-2–infected women, and 21 from HIV-1/2 dually infected women. A total of 344 person-years were at risk of clearance. We observed 126 HPV infections were cleared, including 113 from HIV-1–infected women, 6 from HIV-2–infected women, and 7 from HIV-1/2 dually infected women. The result of log-rank test indicated that the distribution of time until clearance of prevalent HPV infection is the same for women infected by different HIV types at the .05 significance level (P = .5).
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