A longitudinal study of human papillomavirus carriage in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected women,☆☆,

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Abstract

OBJECTIVE: We sought to determine the relationship of human immunodeficiency virus serostatus to carriage of oncogenic human papillomavirus. MATERIAL AND METHODS: A total of 268 human immunodeficiency virus–infected and 265 human immunodeficiency virus–uninfected women were seen every 6 months, at which time they had laboratory tests performed including a CD4 count. Human papillomavirus deoxyribonucleic acid was analyzed by polymerase chain reaction. Statistical methods included Kaplan-Meier and Cox's proportional hazard models. RESULTS: The prevalence at baseline of any human papillomavirus type was 73% and 43% among human immunodeficiency virus–seropositive and seronegative women, respectively (p < 0.0001) and of oncogenic types was 32.5% and 17.0% (p < 0.001). The prevalence of oncogenic human papillomavirus was higher in women with CD4 counts <200 mm3 (p < 0.001). The rate of detection of new oncogenic human papillomavirus per 100 patient years of follow-up in human immunodeficiency virus–seropositive women was almost three times higher than among human immunodeficiency virus–seronegative women (p < 0.01). The rate of loss of an oncogenic human papillomavirus was higher in the human immunodeficiency virus–seronegative women but the difference was not significant. The relative risk of a human immunodeficiency virus–infected woman who did not initially have a specific type of oncogenic human papillomavirus having one detected during follow-up was 6.6 times greater than among human immunodeficiency virus–negative women (p < 0.001). CONCLUSIONS: Human immunodeficiency virus–seropositive women are more likely to have newly detectable oncogenic types of human papillomavirus at follow-up and to show persistent carriage of oncogenic types of human papillomavirus types. Among human immunodeficiency virus–infected women, those with higher CD4 counts were more likely to have a newly detected oncogenic human papillomavirus during follow-up. (Am J Obstet Gynecol 1998;178:982-6.)

Section snippets

Material and methods

Between March 1990 and May 1994 268 human HIV-infected women and 265 HIV-uninfected women were entered into a longitudinal study. They were recruited from the State University Health Science Center at Brooklyn, Kings County Hospital Center, and health care settings in central Brooklyn, an urban, largely minority community. Inclusion criteria for the seropositive women were documented HIV infection without Centers for Disease Control and Prevention defined acquired immunodeficiency syndrome

Results

The prevalence at baseline of any HPV type, oncogenic or nononcogenic, was 73% and 43% among HIV seropositive and seronegative women, respectively (p < 0.0001). The prevalence of oncogenic types in the same groups was 32.5% and 17.0% (p < 0.001). To focus on the HPV types of most clinical importance, the following analyses are limited to oncogenic HPV. Among the HIV-infected and uninfected women, 151 and 261, respectively, had at least one follow-up during which they were tested for oncogenic

Comment

We have found, in a cohort of sexually active women in Brooklyn, that HIV-seropositive women are more likely to have a new oncogenic HPV detected during follow-up and to show persistent carriage of oncogenic HPV types. Because persistent carriage of HPV has previously been linked to chronic cervical dysplasia,8 these findings may have substantial clinical relevance.

Several of our findings are consistent with previous reports focusing on HPV infection among sexually active, presumably

References (23)

  • R Burke et al.

    Declining prevalence of cervicovaginal human papillomavirus infection with age is independent of other risk factors

    J Sex Trans Dis

    (1996)
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    From the Departments of Obstetrics and Gynecology,a Preventive Medicine,b and Internal Medicinec of the State University Health Science Center at Brooklyn and the Departments of Pediatrics, Microbiology and Immunology, Epidemiology and Social Medicine,d Albert Einstein College of Medicine.

    ☆☆

    Reprint requests: Howard Minkoff, MD, Maimonides Medical Center, 967 48th St., Brooklyn, NY 11219.

    6/1/87880

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