AEGiS-13IAC: Immunosuppression and contraceptive practices associated with persistence of human papilloma virus (HPV) in HIV-positive and HIV-negative women.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Immunosuppression and contraceptive practices associated with persistence of human papilloma virus (HPV) in HIV-positive and HIV-negative women.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB235)

Hankins C, Coutlee F, Girard M, Pourreaux K, Lapointe N; C. Hankins, Montreal Regional Public Health Dpt, 1301 Sherbrooke East, Montreal, (Quebec), Canada, Tel.: +1 514 528 2400, Fax: +1 514 528 2452

BACKGROUND: To assess factors associated with persistence of HPV infection among HIV+ and HIV- women participating in the Canadian Womens HIV Study.

METHODS: 108 HPV+ HIV+ asymptomatic women aged 15-44 years without dysplasia and 71 HPV+ HIV- controls were tested using a tampon or cervical vaginal lavage specimen for HPV 6 months and 12 months following initial HPV detection by polymerase chain reaction. Persistence was defined as 2 HPV+ results and non-persistence as 2 HPV- results subsequent to the first detection. CD4 counts were determined locally and clinical and behavioural questionnaires completed. Factors associated with persistence of HPV in general and of oncogenic types were evaluated using logistic regression.

RESULTS: 87% (94/108) of HIV+ versus 52.1% (37/71) of HIV- women had general HPV persistence (p = 0.001). In HIV+ women, 95.8% (23/24) of women with CD4+ > 200 at the third visit had persistent HPV versus 84.3% (70/83) of those with CD4 ? 200 (p = 0.14). General persistence (GP) was associated with race (p = 0.03), HIV status (p = 0.001), CD4+ count (p = 0.03) & not being on oral contraceptives (p = 0.008). In logistic regression controlling for race and age, GP was associated with CD4+ > 200 (AOR = 7.95, p = 0.048) and oral contraception (OC) appeared protective (AOR = 0.397;p = 0.024). Oncogenic types were found in 85.2% of HIV+ women (92/108) vs 74.6% of HIV- women (53/71) (p = 0.08). Persistence of oncogenic types was 59.3% (64/108) in HIV+ and 32.4% (23/71) in HIV- women (p = 0.001). Oncogenic persistence was associated with CD4+ > 200 (AOR = 3.042; p = 0.0294), OC (AOR = 0.463; p = 0.065) after controlling for race and age.

CONCLUSION: HPV, and particularly oncogenic HPV, is more likely to persist in women co-infected with HIV. In this study, immunosuppression and not being on oral contraception were associated with persistence. HIV+ women should be counselled to avoid acquiring HPV and to have regular cytological examinations for early detection of dysplasia.

Keywords: AEGIS, Papillomavirus, Human, HIV, HIV Seropositivity, HIV Infections, CD4 Lymphocyte Count, Immunosuppression, HIV Seronegativity, Immune Tolerance, Polymerase Chain Reaction, Canada, North America, Greece, Human, Female, immunology
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MoOrB235