A comparison of the natural history of HPV infection and cervical abnormalities among HIV-positive and HIV-negative women in Senegal, Africa

Hilary K. Whitham, Stephen E. Hawes, Haitao Chu, J. Michael Oakes, Alan R. Lifson, Nancy B. Kiviat, Papa Salif Sow, Geoffrey S. Gottlieb, Selly Ba, Marie P. Sy, Shalini L. Kulasingam

Research output: Contribution to journalReview article

12 Scopus citations

Abstract

Background: There is evidence of an interaction between HIV and human papillomavirus (HPV) resulting in increased HPV-associated morbidity and cancer mortality among HIV-positive women. This study aims to determine how the natural history of cervical HPV infection differs by HIV status. Methods: A total of 1,320women (47% were positive for HIV-1 and/or HIV-2) were followed for an average of two years in Senegal, West Africa between 1994 and 2010. Cytology (with a sub-sample of histology) andHPVDNAtesting were performed at approximately 4-month intervals yielding data from over 7,900 clinic visits. Competing risk modeling was used to estimate rates for transitioning between three clinically relevant natural history stages: Normal, HPV, and HSIL (high-grade squamous intraepithelial lesions). Among HIV-positive women, exploratory univariate analyses were conducted examining the impact of HPV type, infection with multiple HPV types, HIV type, CD4+ count, and age. Results: HIV-positive women had higher rates of progression and lower rates of regression compared with HIV-negative women (i.e., adverse transitions). HIV-positive women had a 2.55 [95% confidence interval (CI), 1.69-3.86; P < 0.0001] times higher rate of progression from HPVto HSIL than HIV-negative women (with 24-month absolute risks of 0.18 and 0.07, respectively). Among HIV-positive women, HPV-16/18 infection and CD4+ count <200/mm3 were associated with adverse transitions. Conclusions: Adverse HIV effects persist throughout HPV natural history stages. Impact: In the limited-resource setting of sub-Saharan Africa where cervical cancer screening is not widely available, the highrisk population of HIV-positive women may be ideal for targeted screening.

Original languageEnglish (US)
Pages (from-to)886-894
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2017

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