Prevalent and persistent oncogenic HPV types in a cohort of women living with HIV prior to HPV vaccination

HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV

BACKGROUND

Several co-factors for HPV oncogenesis have been proposed, including co-infection with HSV-2. We assessed the relationship between HSV-2 infection and HPV-related outcomes in quadrivalent HPV-vaccinated (qHPV) women living with HIV (WLWH).

METHODS

In this multi-site study of immunogenicity and efficacy of the qHPV vaccine in WLWH, visits took place at months -3, 0, 2, 6, 12, 18, 24, and annually thereafter. Participants provided clinical data and cervico-vaginal swabs for HPV DNA detection; baseline serum was tested for HSV-2 type-specific antibodies. We used non-parametric statistics to compare HPV-related outcomes by HSV-2 serostatus and use of anti-HSV medication.

RESULTS

151 baseline serum samples underwent HSV-2 testing. At baseline, median age was 39 years, median CD4 count was 500 cells/mm³, and 70% had an HIV viral load of <50 copies/mL. Baseline HSV-2 seroprevalence was 76.2%. HSV-2 seropositivity was associated with increased age (p = 0.006). Controlling for age and median CD4 count, HSV-2 seropositivity was not associated with HPV incidence, persistence, and precancerous lesions. The use of anti-HSV medications was associated with higher odds of HSIL cytology (OR = 3.35, 95% CI = 1.03,11.26) and a greater number of HPV types detected (OR = 1.18, 95% CI = 1.00,1.39). Results were similar in sensitivity analyses using an index value of 3.5. The presence of HSV lesions during the study was not associated with HPV outcomes.

CONCLUSIONS

HSV-2 seropositivity was common in this cohort of WLWH in Canada but was not associated with multiple measures of HPV incidence, persistence, and precancerous lesions. However, the use of anti-HSV medications was associated with HSIL cytology and number of HPV types detected.

Associations of human papillomavirus (HPV) genotypes and related risk factors in a cohort of women living with HIV in a Brazilian countryside city

The human papillomavirus (HPV) is associated with cervical abnormalities. People living with HIV are more susceptible to HPV. Campos dos Goytacazes implemented the quadrivalent HPV vaccine (4vHPV) for women living with HIV (WLWH) in 2011, 4 years before the Brazilian public vaccination program. We aimed to characterize the genomic diversity and predictors of HPV infection in WLWH through a prospective cohort study. After the consent form was received, a questionnaire was applied and an endocervical sample was collected. For genotyping, a microarray HPV technique was performed. Two intervention moments were performed: T1, the initial moment, with collection and vaccination; T2 moment, 2 years after T1. Univariate and multivariate analyses were performed. The T1 moment cohort was formed by 146 women,107 belonging to Group 1(HPV-negative) and 39 to Group 2 (HPV-positive). The variables age, marital status, number of children, number of sexual partners, and CD4 count were protective against HPV. The variables number of sexual partners, marital status, and the number of children lost significance in multivariate analysis. Concerning T2 moment, 42 patients were followed with three positive cases. The use of 4vHPV is beneficial for this population and should also be recommended at an age from 26 to 45 years inside the public vaccination program.

Type-specific persistence, clearance and incidence of high-risk HPV among screen-positive Rwandan women living with HIV

BACKGROUND

Persistent infection with high-risk human papillomavirus (hrHPV) is a critical step in cervical carcinogenesis. We report on type-specific hrHPV persistence, clearance and incidence among screen-positive Rwandan women living with HIV (WLWH).

METHODS

This was a nested analysis from a large cervical cancer screening study of ~ 5000 Rwandan WLWH. Women who tested positive for hrHPV and/or visual inspection with acetic acid were referred to colposcopy. For a subset of women (n = 298) who were ≥ 6 months delayed in receiving colposcopy, we tested their screening and colposcopy visit specimens using the AmpFire HPV genotyping assay that tests 14 hrHPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) individually.

RESULTS

The mean, median (interquartile range [IQR]) and range of time between the screening and colposcopy visits were 644, 650 (490-820.5) and 197-1161 days, respectively. Mean, median (IQR) and range of age at the screening visit were 38, 37 (34-43) and 30-54 years, respectively. Two-hundred eighty-three (95.0%) had CD4 count (cells per mm³) data available at baseline with mean, median (IQR) and range of 592, 513 (346-717) and 0-7290, respectively. Two-hundred thirty-five WLWH were positive for at least one hrHPV type at the screening visit, of whom 50.2% had at least one HPV type-specific infection persist; 37.2% of all HPV infections detected at the screening visit persisted. Compared to all other HPV types in aggregate, HPV16 (vs. non-HPV16 types) (47.7%, p = 0.03) and HPV33 (vs. non-HPV33 types) (56.7%, p = 0.03) were significantly more likely, and HPV39 (vs. non-HPV39 types) (6.7%, p = 0.01), HPV51 (vs. non-HPV51 types) (15.6%, p < 0.01), and HPV66 (vs. non-HPV66 types (17.9%, p = 0.04) were significantly less likely, to persist. Lower CD4 counts were associated with having any persistent hrHPV infection (p_trend = 0.04) and multiple persistent hrHPV infections (p_trend = 0.04).

CONCLUSION

There is a significant proportion of WLWH with persistent hrHPV infection, emphasizing the need to vaccinate them against HPV prior to becoming sexually active.