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

L. Stewart Massad, Xianhong Xie, Robert D. Burk, Gypsyamber D'Souza, Teresa M. Darragh, Howard Minkoff, Christine Colie, Pamela Burian, Joel Palefsky, Jessica M. Atrio, Howard Strickler

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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.

Original languageEnglish (US)
Pages (from-to)354.e1-354.e6
JournalAmerican Journal of Obstetrics and Gynecology
Volume214
Issue number3
DOIs
StatePublished - Mar 1 2016

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Human papillomavirus 16
HIV
Odds Ratio
Confidence Intervals
Papanicolaou Test
Papillomavirus Vaccines
Cervical Intraepithelial Neoplasia
Therapeutic Irrigation
Infection
Uterine Cervical Neoplasms

Keywords

  • cervical intraepithelial neoplasia
  • HIV in women
  • human papillomavirus
  • viral oncogenesis

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women. / Stewart Massad, L.; Xie, Xianhong; Burk, Robert D.; D'Souza, Gypsyamber; Darragh, Teresa M.; Minkoff, Howard; Colie, Christine; Burian, Pamela; Palefsky, Joel; Atrio, Jessica M.; Strickler, Howard.

In: American Journal of Obstetrics and Gynecology, Vol. 214, No. 3, 01.03.2016, p. 354.e1-354.e6.

Research output: Contribution to journalArticle

Stewart Massad, L. ; Xie, Xianhong ; Burk, Robert D. ; D'Souza, Gypsyamber ; Darragh, Teresa M. ; Minkoff, Howard ; Colie, Christine ; Burian, Pamela ; Palefsky, Joel ; Atrio, Jessica M. ; Strickler, Howard. / Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women. In: American Journal of Obstetrics and Gynecology. 2016 ; Vol. 214, No. 3. pp. 354.e1-354.e6.
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title = "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.",
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T1 - Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women

AU - Stewart Massad, L.

AU - Xie, Xianhong

AU - Burk, Robert D.

AU - D'Souza, Gypsyamber

AU - Darragh, Teresa M.

AU - Minkoff, Howard

AU - Colie, Christine

AU - Burian, Pamela

AU - Palefsky, Joel

AU - Atrio, Jessica M.

AU - Strickler, Howard

PY - 2016/3/1

Y1 - 2016/3/1

N2 - 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.

AB - 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.

KW - cervical intraepithelial neoplasia

KW - HIV in women

KW - human papillomavirus

KW - viral oncogenesis

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