Elsevier

Obstetrics & Gynecology

Volume 96, Issue 3, 23 August 2000, Pages 403-409
Obstetrics & Gynecology

Original article
Increased risk of cervical disease among human immunodeficiency virus–infected women with severe immunosuppression and high human papillomavirus load1,

https://doi.org/10.1016/S0029-7844(00)00948-0Get rights and content

Abstract

Objective: To investigate human papillomavirus (HPV) genotypes, HPV DNA load, and behavioral and sociodemographic factors in a series of human immunodeficiency virus (HIV)-seropositive women, and to correlate HPV infection with cervical disease according to immune status.

Methods: Three hundred seven HIV-seropositive women were tested for the presence of HPV DNA by polymerase chain reaction (PCR) and Southern blot hybridization. Cervical disease was assessed using Papanicolaou smears, colposcopy, and biopsies when necessary. Various risk factors for cervical intraepithelial neoplasia (CIN) were tested using multiple logistic regression analysis.

Results: Cervical disease was diagnosed in 83 (27.0%) of 307 women and HPV infection in 162 (52.8%). High HPV load (as detectable by Southern blot hybridization) was found in 90 (55.6%) of the 162 infected women. Potentially oncogenic or related genotypes were detected in 74 (82.2%) of these 90 cases. High-load HPV infection was twice as frequent in severely immunosuppressed women (CD4 cell count less than 200/μL) as in women with higher CD4 cell counts (P = .002). High-load HPV infection was associated with a high risk of cervical disease (adjusted odds ratio [OR] 16.8; 95% confidence interval [CI] 7.0, 40.3). The risk among severely immunosuppressed women was ten times greater than that among women with CD4 cell counts of at least 200/μL. Low-load HPV infection (detected by PCR only) was a risk factor for CIN in severely immunosuppressed women only (adjusted OR 7.4; 95% CI 1.3, 43.0).

Conclusion: Immunosuppression favors cervical high-load HPV infection with oncogenic genotypes and its clinical expression in HIV-seropositive women.

Section snippets

Materials and methods

Between June 1993 and February 1996, 307 HIV-seropositive women attending the outpatient clinics of Hôpital Broussais and the Department of Obstetrics and Gynecology of Hôpital Cochin, Paris, were enrolled in a prospective study of cervical disease in HIV-seropositive women. The protocol was reviewed and approved by the French National Agency for AIDS Research. All women gave informed consent to participate in the study and were interviewed using a standardized questionnaire with questions

Results

The women included in the study were aged between 19 and 72 years, with a median age of 32 years. Two hundred twelve women (69%) were white, 80 (26%) were black or Caribbean, and the remaining 15 had various ethnic backgrounds. The mode of HIV transmission was heterosexual contact in 184 women (60%), intravenous drug use in 90 (29%), transfusion of contaminated blood products in 14 (5%), and unknown in 19 (6%). Seventy-seven women had histories of abnormal Papanicolaou smears (44 [14.3%] had

Discussion

In this series of 307 HIV-seropositive women, a high prevalence (27%) of biopsy-confirmed cervical disease was observed, in agreement with previous reports.8, 10 A proportion of the women (18.2%) could not undergo biopsies despite abnormal Papanicolaou smears and/or minor colposcopic lesions, suggesting that the overall prevalence of CIN may have been underestimated. A high prevalence of HPV infection (52.8%) was noted in our study population when PCR and Southern blot hybridization data were

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  • Cited by (0)

    This study was supported by INSERM, the Agence Nationale de Recherches sur le SIDA, and SIDACTION, France.

    1

    The authors are grateful to J.-D. Poveda (Centre de Biologie Médicale Spécialisée, Institut Pasteur) for his help with human papillomavirus typing.

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