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JNCI Journal of the National Cancer Institute 1999 91(3):226-236; doi:10.1093/jnci/91.3.226
© 1999 by Oxford University Press
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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

Joel M. Palefsky, Howard Minkoff, Leslie A. Kalish, Alexandra Levine, Henry S. Sacks, Patricia Garcia, Mary Young, Sandra Melnick, Paolo Miotti, Robert Burk

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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