Risk factors for human papillomavirus infection in women with different HIV status

BACKGROUND: Cervical cancer is a leading cause of death in women worldwide. The primary driver of its development is the human papillomavirus (HPV). In women infected with HIV, the prevalence of HPV and, consequently, the incidence of HPV-associated lesions of the cervix and vagina, is higher than in the general population. To prevent these diseases, it is important to understand the factors that increase the risk of HPV infection. AIM: The aim of this study was to assess the risk factors for HPV infection in women with different HIV status living in St. Petersburg, Russia. METHODS: This case-control included 100 HIV-infected women (main group) and 100 HIV-negative women (control group) living in St. Petersburg, Russia. Polymerase chain reaction was used to determine the DNA of 21 HPV types, plasma HIV RNA, and CD4+ lymphocyte counts in vaginal and cervical secretions. The clinical and epidemiological characteristics were examined. RESULTS: The frequency of HPV detection in the vagina and cervical canal was 55% in HIV-infected women and 32% in HIV-negative women. In patients with HIV, the presence of HPV was associated with such clinical characteristics as the duration of HIV infection, the duration of antiretroviral therapy, HIV RNA levels, and CD4+ lymphocyte count. HPV was most frequently detected in the first year after HIV diagnosis, and then the probability of HPV detection decreased almost tenfold as the duration of the disease increased. With a one-year increase in the duration of antiretroviral therapy, the probability of HPV detection in the cervical canal decreased by 1.14 times, and when HIV RNA levels in the blood were 40 copies/ml, HPV prevalence increased by 4.71 times. In the control group, the main risk factors for HPV infection were smoking, the onset of sexual activity before the age of 18, and a large lifetime number of sexual partners. CONCLUSION: In HIV-positive women, HPV prevalence is influenced by the following clinical characteristics: detectable HIV viral load and immunodeficiency increase the risk of HPV detection, while the use of antiretroviral therapy reduces the risk of HPV infection.