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10th Anniversary Conference Of The British HIV Association [BHIVA]15 – 17 April 2004, City Hall, Cardiff, UK |
[AUTHOR(S):] BM Holden, DK Gill, M Byrne, CJN Lacey
St Mary's Hospital and Imperial College, London, UK
BHIVA Conf 2004 Apr 15-17;10:O27
BACKGROUND: HR HPV causes cervical pre-cancer/cancer. We investigated the value of HPV testing in HIV-positive women.
METHODS: In a prospective cohort of women from a colposcopy clinic, HPV typing (by polymerase chain reaction, using MY09/MY11, Roche reverse line blot) was performed, demographics recorded and the status of cervical disease established at entry to the study.
RESULTS: 72 women were recruited over a period of 18 months; 72% were on highly active antiretroviral therapy, 67% had >200 CD4 cells/µl and 42% had an undetectable viral load. The prevalence of HPV was 44%; 24% had eight HR HPV types and 20% of women had untyped HPV. HPV-58 and MM7 were the commonest defined HPVs. There were no 'low oncogenic risk' types. At baseline, 49% had a normal cervix, 43% low-grade changes, 7% had high-grade cervical pre-cancer and there was no biopsy-proven cervical intraepithelial neoplasia (CIN) grade 3. The prevalence of HPV infection by grade of cervical pathology was: 13% with a normal cervix, 61% with lowgrade disease and 60% (three of five) had high-grade disease; these latter three women with high-grade squamous intraepithelial lesions (HSILs) all had untyped HPV. Defining new HSILs, loop excision of the transformation zone and cone biopsy as endpoints, only three women progressed, all of whom had loop excision (one HSIL, two low-grade squamous intraepithelial lesions): two were HPV-negative at entry and one had untyped HPV.
CONCLUSIONS: Use of antiretroviral therapy led to a low average burden of HIV replication. About 7% of women had evidence of HSIL at entry, and 4% developed it during the follow-up. HPV typing is not useful because: (1) untyped/uncommon HPV types are frequent and (2) the test is insensitive in the setting of low-incidence HSIL.
PRESENTING AUTHOR: BM Holden
040415
O27
Copyright © 2004 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD