Isabelle Heard1, Isabelle Poizot-Martin2, Valérie Potard3, Isabelle Etienney4, Catherine Crenn-Hebert5, Catherine Moore6, Philippe Touraine7, Heather Cubie6, Dominique Costagliola8. 1. French Human Papillomavirus Reference Laboratory, Institut Pasteur Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris. 2. Aix Marseille Univ, Sainte-Marguerite Hospital, Immuno-hematology Clinic Unit, Assistance Publique, Hôpitaux de Marseille Inserm U912, Marseille. 3. Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique INSERM Transfert, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris. 4. Proctologie Unit, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris. 5. Assistance Publique, Hôpitaux de Paris, Hôpital Mourier, Colombes, France. 6. Scottish HPV Reference Laboratory, Edinburgh, United Kingdom. 7. Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris. 8. Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
Abstract
BACKGROUND: Little is known about the type-specific prevalence of anal human papillomavirus (HPV) infection and risk factors for anal high-risk (HR) HPV infection in human immunodeficiency virus (HIV)-infected women. METHODS: A cross-sectional study of anal and cervical HPV infection was nested within a gynecological cohort of HIV-infected women. Specimens were tested for type-specific DNA using a polymerase chain reaction-based assay. RESULTS: The study population consisted of 311 women with a median age of 45.3 years, of whom 42.8% originated from sub-Saharan Africa and 96.8% were receiving combination antiretroviral therapy. The median CD4(+)cell count was 612/μL, and the HIV load was <50 copies/mL in 84.1%. HR-HPV types were detected in the anal canal in 148 women (47.6%) and in the cervix in 82 (26.4%). HPV-16 was the most prevalent type in both the anal canal (13.2% of women) and the cervix (5.1%). In multivariable analysis, factors associated with prevalent anal HR-HPV infection were CD4(+)count <350/μL (odds ratio, 2.9; 95% confidence interval, 1.3-6.5), concurrent cervical lesions (2.6; 1.0-4.3), and cervical HR-HPV infection (1.8; 1.0-3.2). CONCLUSIONS: The high prevalence of HR-HPV types, including HPV-16, in the anal canal of HIV-positive women is concerning. Anal cancer screening should be considered for HIV-positive women as part of their routine care.
BACKGROUND: Little is known about the type-specific prevalence of anal human papillomavirus (HPV) infection and risk factors for anal high-risk (HR) HPV infection in human immunodeficiency virus (HIV)-infectedwomen. METHODS: A cross-sectional study of anal and cervical HPV infection was nested within a gynecological cohort of HIV-infectedwomen. Specimens were tested for type-specific DNA using a polymerase chain reaction-based assay. RESULTS: The study population consisted of 311 women with a median age of 45.3 years, of whom 42.8% originated from sub-Saharan Africa and 96.8% were receiving combination antiretroviral therapy. The median CD4(+)cell count was 612/μL, and the HIV load was <50 copies/mL in 84.1%. HR-HPV types were detected in the anal canal in 148 women (47.6%) and in the cervix in 82 (26.4%). HPV-16 was the most prevalent type in both the anal canal (13.2% of women) and the cervix (5.1%). In multivariable analysis, factors associated with prevalent anal HR-HPV infection were CD4(+)count <350/μL (odds ratio, 2.9; 95% confidence interval, 1.3-6.5), concurrent cervical lesions (2.6; 1.0-4.3), and cervical HR-HPV infection (1.8; 1.0-3.2). CONCLUSIONS: The high prevalence of HR-HPV types, including HPV-16, in the anal canal of HIV-positive women is concerning. Anal cancer screening should be considered for HIV-positive women as part of their routine care.
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