© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 3, 226-236,
February 3, 1999
© 1999 Oxford University Press
ARTICLES |
Cervicovaginal Human Papillomavirus Infection in Human Immunodeficiency Virus-1 (HIV)-Positive and High-Risk HIV-Negative Women
Affiliations of authors: J. M. Palefsky, University of California, San Francisco; H. Minkoff, State University of New York, NY; L. A. Kalish, New England Research Institutes, Watertown, MA; A. Levine, University of Southern California, Los Angeles; H. S. Sacks, Mount Sinai Medical Center, New York, NY; P. Garcia, Northwestern University, Chicago, IL; M. Young, Georgetown University, Washington, DC; S. Melnick, National Cancer Institute, Bethesda, MD; P. Miotti, National Institute of Allergy and Infectious Diseases, Bethesda; R. Burk, Albert Einstein College of Medicine, New York, NY.
Correspondence to: Joel M. Palefsky, M.D., Department of Laboratory Medicine, University of California, San Francisco, Rm. C634, Box 0100, San Francisco, CA 94143 (e-mail: joelp{at}labmed.ucsf.edu).
BACKGROUND: Human papillomavirus (HPV) infection is
associated with precancerous cervical squamous intraepithelial lesions
commonly seen among women infected with human immunodeficiency virus-1
(HIV). We characterized HPV infection in a large cohort of HIV-positive
and HIV-negative women participating in the Women's Interagency HIV
Study to determine the prevalence of and risk factors for
cervicovaginal HPV infection in HIV-positive women. METHODS:
HIV-positive (n = 1778) and HIV-negative (n = 500) women were
tested at enrollment for the presence of HPV DNA in a cervicovaginal
lavage specimen. Blood samples were tested for HIV antibody status,
level of CD4-positive T cells, and HIV RNA load (copies/mL). An
interview detailing risk factors was conducted. Univariate and
multivariate analyses were performed. RESULTS: Compared with
HIV-negative women, HIV-positive women with a CD4+ cell count
of less than 200/mm3 were at the highest risk of HPV
infection, regardless of HIV RNA load (odds ratio [OR] = 10.13;
95% confidence interval [CI] = 7.32-14.04), followed by women
with a CD4+ count greater than 200/mm3 and an HIV
RNA load greater than 20 000 copies/mL (OR = 5.78; 95% CI =
4.17-8.08) and women with a CD4+ count greater than
200/mm3 and an HIV RNA load less than 20 000
copies/mL (OR = 3.12; 95% CI = 2.36-4.12), after adjustment for
other factors. Other risk factors among HIV-positive women included
racial/ethnic background (African-American versus Caucasian, OR = 1.64;
95% CI = 1.19-2.28), current smoking (yes versus no; OR = 1.55;
95% CI = 1.20-1.99), and younger age (age <30 years versus
40 years; OR = 1.75; 95% CI = 1.23-2.49).
CONCLUSIONS: Although the strongest risk factors of HPV
infection among HIV-positive women were indicators of more advanced
HIV-related disease, other factors commonly found in studies of
HIV-negative women, including racial/ethnic background, current
smoking, and age, were important in HIV-positive women as well.
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