Ahdieh L, Munoz A, Vlahov D, Trimble C, Timpson L, Shah K; Conference on Retroviruses and Opportunistic Infections.

Program Abstr 6th Conf Retrovir Oppor Infect Conf Retrovir Oppor Infect 6th 1999 Chic Ill. 1999 Jan 31-Feb 4; 6th: 154 (abstract no. 463).

Johns Hopkins University, Schools of Public Health and Medicine, Baltimore, MD.

Objectives: We investigated the hypothesis that HIV infection and immunosuppression facilitate the persistence of HPV infection, and that the effect of HIV on cervical neoplasia (CIN) can be explained by its effect on HPV persistence. Methods: As part of a longitudinal study with bi-annual examinations (The ALIVE Study), 184 HIV+ women and 84 HIV- women provided 924 and 502 cervicovaginal lavage specimens, respectively. HPV DNA was detected and typed by a PCR-based assay. We compared levels of HPV positivity as well as time to HPV clearance in groups of participants categorized by baseline HIV status and CD4 cell count among HIV+ women using models for correlated binary data and survival analysis. Colposcopic examinations and biopsies were conducted to quantify the extent to which HPV persistence explained the association between HIV and CIN. Results: Among the 187 women with visits subsequent to the first HPV positive measurement, the probability of HPV positivity was 47.5%, 78.7%, and 92.9% (p < 0.001) among HIV- women, HIV+ women with CD4 200 mm3, and HIV+ women with CD4 < 200 mm3. In addition to the trend in HPV positivity, we detected significant levels of clustering (p < 0.01) in each of the three groups. The rate of HPV clearance in HIV+ women with CD4 200 mm3 and HIV+ women with CD4 < 200 mm3 was only 0.29 (CI: 0.17, 0.48) and 0.10 (CI: 0.04, 0.28) the rate of clearance of HIV- women. A total of 107. women were evaluated with colposcopic examinations and 11 had biopsy-confirmed CIN. The significant (p=0.014) univariate association of HIV and CIN was fully explained (p=0.648) by level of HPV persistence induced by HIV infection. Persistence of HPV was strongly (p < 0.001) associated with CIN. Conclusions: HIV-associated immunosuppression was associated with HPV persistence. Although HIV infection was highly related to CIN in univariate analyses, this association was mediated by higher levels of HPV persistence in HIV+ women.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• CD4 Lymphocyte Count
• Cervical Intraepithelial Neoplasia
• Communicable Diseases
• Female
• HIV
• HIV Infections
• HIV Seronegativity
• HIV Seropositivity
• Humans
• Longitudinal Studies
• Papillomaviridae
• immunology

Other ID:

• 20711702

UI: 102195232

From Meeting Abstracts