A cross-sectional study of high-risk human papillomavirus clustering and cervical outcomes in HIV-infected women in Rio de Janeiro, Brazil.
Jun 23 2015
Pub PDF: 12885_2015_Article_1486.pdf
Background: In Brazil, the rate of cervical cancer remains high despite the availability of screening programs. With
ongoing vaccine development and implementation, information on the prevalence of specific HPV types is needed,
particularly among high-risk populations, such as HIV-infected women.
Methods: We performed a study of HIV-infected women in Rio de Janeiro, Brazil, who underwent cervical HPV
genotype testing between 2005-2013. We examined the prevalence of high-risk HPV types and the patterns of
high-risk HPV type clustering. Using logarithmic binomial regression, we estimated the risk of abnormal cytology by
HPV genotype result.
Results: Of the 562 women included, 498 (89 %) had at least one HPV type detected. 364 women (65 %) had at
least one high-risk HPV type detected and 181 (32 %) had more than one high-risk type detected. HPV 58 was the
most frequent HPV type detected overall (prevalence 19.8 % [95 % confidence interval 16.4–23.1]), followed by HPV
53 (prevalence 15.5 % [12.5–18.5]) and HPV 16 (prevalence 13 % [10.2–15.8]). Women infected with more than one
high-risk HPV type were younger, had lower CD4+ lymphocyte counts, and were more likely to be infected with
HPV 16 or 18. In adjusted analyses, presence of more than one high-risk HPV type was associated with a two-fold
increased risk of abnormal cytology after adjusting for presence of individual high-risk type, age, and CD4+ lymphocyte
count (adjusted prevalence ratios 1.88–2.07, all p <0.001). No single high-risk HPV type was statistically associated with
abnormal cytology after adjusting for the presence of more than one high-risk HPV type.
Conclusions: In the largest study of cervical HPV genotypes among HIV-infected women in Latin America, infection by
high-risk HPV types other than 16 or 18 and infection by more than one high-risk HPV types were common. Infection
by more than one high-risk type was more strongly associated with abnormal cervical cytology than any individual
high-risk HPV type, highlighting the need for multi-valent HPV vaccines.
Keywords: HPV, Women, HIV, Cervical cancer, Epidemiology
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Castilho JL, Levi JE, Luz PM, Cambou MC, Vanni T, de Andrade A, Derrico M, Veloso VG, Grinsztejn B, Friedman RK. A cross-sectional study of high-risk human papillomavirus clustering and cervical outcomes in HIV-infected women in Rio de Janeiro, Brazil. BMC Cancer. 2015 Jun 23;15:478. doi: 10.1186/s12885-015-1486-4. PubMed PMID: 26100400; PubMed Central PMCID: PMC4477502.