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Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women.

Abstract：

BACKGROUND:HIV-seropositive women face high risk for infection with oncogenic human papillomavirus (oncHPV) types, abnormal Pap test results, and precancer, but cervical cancer risk is only modestly increased. Human papillomavirus (HPV)16 is highly oncogenic but only weakly associated with HIV status and immunosuppression, suggesting HPV16 may have a greater innate ability to evade host immune surveillance than other oncHPV types, which in turn should result in a greater relative increase in the prevalence of other oncHPV types among women with cervical precancer. OBJECTIVE:We sought to assess whether the underrepresentation of HPV16 among HIV-seropositive relative to HIV-seronegative women remains among those with cervical precancers. STUDY DESIGN:HIV-seropositive and HIV-seronegative women in the Women's Interagency HIV Study were screened for cervical intraepithelial neoplasia (CIN) grade ≥3 (CIN3(+)). DNA from >40 HPV types was detected by polymerase chain reaction in cervicovaginal lavage specimens obtained at the visit at which CIN3(+) was diagnosed. RESULTS:HPV16 was detected in 13 (62%) of 21 HIV-seronegative women with CIN3(+) but only 44 (29%) of 154 HIV-seropositive women with CIN3(+) (P = .01). The lower prevalence of HPV16 in CIN3(+) among HIV-seropositive women persisted after controlling for covariates (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08-0.78). The prevalence of other members of the HPV16-related alpha-9 oncHPV clade as a group was similar in HIV-infected and uninfected women with CIN3(+) (OR, 1.02; 95% CI, 0.53-1.94). The prevalence of non-alpha-9 oncHPV types was increased in HIV-seropositive vs HIV-seronegative women with CIN3(+) (OR, 3.9; 95% CI, 1.3-11.8). CONCLUSION:The previously demonstrated increase in CIN3(+) incidence among HIV-seropositive women is associated with lower HPV16 and higher non-alpha-9 oncHPV prevalence. This is consistent with prior reports that HIV has a weak effect on infection by HPV16 relative to other oncHPV and supports use of nonavalent HPV vaccine in HIV-seropositive women.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Massad LS,Xie X,Burk RD,D'Souza G,Darragh TM,Minkoff H,Colie C,Burian P,Palefsky J,Atrio J,Strickler HD

doi

10.1016/j.ajog.2015.09.086

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

354.e1-6

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(15)01200-4

journal_volume

214

pub_type

杂志文章,多中心研究

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Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women.