PROCAARE: RELATED EPIDEMICS--Papillomavirus

["Gerard J. Nau (Jerry)" <gnau@usa.healthnet.org>]

KEYWORDS--PAPILLOMAVIRUS/HIV-1/HIV-2/WOMEN/SENEGAL
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Reference:  Langley, C., Benga-De, E., Critchlow, C., Ndoye, I., 
Mbengue-Ly, M., Kuypers, J., Woto-Gaye, G., Mboup, S., Bergeron, C., 
Holmes, K., and N. Kiviat. (1996)  HIV-1, HIV-2, human papillomavirus 
infection and cervical neoplasia in high-risk African women.  AIDS  
10:413-417.

This cross-sectional study of women commercial sex workers in Senegal 
evaluated the prevalence of human papillomavirus (HPV) infection and its 
association with HIV-1 and/or HIV-2.

Of 759 total subjects, 68 were seropositive with HIV-1, 58 with HIV-2, 14 
with both, and 619 were seronegative.  HIV-1 and dually infected women 
had lower CD4 counts compared to HIV-2 infected women whose counts were 
nearly equivalent to the HIV-negative women (820, 727, 1205, 1447 
million/L respectively).  Compared to seronegative women, HIV infection 
with either virus raised the odds ratio for prevalence of HPV (detected 
by PCR or Southern hybridization) to 2.9 (HIV-1, 95% confidence intervals 
1.7-4.9) and 1.7 (HIV-2, CI 1.0-2.9); dual infection raised the risk to 
4.9 (CI 0.8-10.3).  The odds ratios for cervical squamous intraepithelial 
lesions (SIL) were 1.8 (HIV-1, CI 0.7-4.7), 2.9 (HIV-2, CI 1.2-7.2), and 
5.2 (dual, CI 1.4-19.6). 

These results demonstrate that the prevalence for HPV infection and the 
risk for precancerous lesions were higher in women with HIV infection.  
Previous studies had demonstrated an increased risk of HPV and SIL with 
increasing immunosuppression.  Interestingly, this study found a similar 
risk between HIV-1 and HIV-2 infection even though the level of 
immunosuppression was not as dramatic as that seen in HIV-1 infection.  

The results also underscore the need for diligent screening for HPV and 
its associated dysplasia in the HIV infected population.