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Prevalence of risk factors associated with human papillomavirus infection in women living with HIV. Canadian Women's HIV Study Group.
CMAJ. 1999 Jan 26; 160(2):185-91.CMAJ

Abstract

BACKGROUND

Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examined risk factors for HPV infection at study entry in HIV-positive women enrolled in the Canadian Women's HIV Study, a prospective open cohort study.

METHODS

Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women's HIV Study for whom HPV test results were available. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detection and typing by polymerase chain reaction were obtained at study entry.

RESULTS

Overall, 67.2% (252/375) of the women were HPV-positive; the global prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% (184/375). Women with squamous cell dysplasia (32/294) were more likely to have HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of lifetime partners and history of STD, revealed that the following risk factors were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (Cl) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% Cl 1.17-3.42 (p = 0.011)]), inconsistent condom use in the 6 months before study entry (adjusted OR 2.02 [95% Cl 1.16-3.50 (p = 0.013)]), and lower age, with women age 30-39 years (adjusted OR 0.51 [95% Cl 0.30-0.87 (p = 0.013)]) and age 40 years or older (adjusted OR 0.52 [95% Cl 0.26-1.01 (p = 0.052)]) compared with women less than 30 years of age.

INTERPRETATION

Close monitoring for HPV-related effects is warranted in all HIV-positive women, particularly younger, non-white women who do not always use condoms. Counselling for women living with HIV, particularly younger women, should emphasize the importance of regular cytological screening, with increasing frequency as the CD4 count falls.

Authors+Show Affiliations

Infectious Diseases Unit, Montreal Regional Public Health Department, Que. md77@musica.mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9951439

Citation

Hankins, C, et al. "Prevalence of Risk Factors Associated With Human Papillomavirus Infection in Women Living With HIV. Canadian Women's HIV Study Group." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 160, no. 2, 1999, pp. 185-91.
Hankins C, Coutlée F, Lapointe N, et al. Prevalence of risk factors associated with human papillomavirus infection in women living with HIV. Canadian Women's HIV Study Group. CMAJ. 1999;160(2):185-91.
Hankins, C., Coutlée, F., Lapointe, N., Simard, P., Tran, T., Samson, J., & Hum, L. (1999). Prevalence of risk factors associated with human papillomavirus infection in women living with HIV. Canadian Women's HIV Study Group. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 160(2), 185-91.
Hankins C, et al. Prevalence of Risk Factors Associated With Human Papillomavirus Infection in Women Living With HIV. Canadian Women's HIV Study Group. CMAJ. 1999 Jan 26;160(2):185-91. PubMed PMID: 9951439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of risk factors associated with human papillomavirus infection in women living with HIV. Canadian Women's HIV Study Group. AU - Hankins,C, AU - Coutlée,F, AU - Lapointe,N, AU - Simard,P, AU - Tran,T, AU - Samson,J, AU - Hum,L, PY - 1999/2/10/pubmed PY - 1999/2/10/medline PY - 1999/2/10/entrez SP - 185 EP - 91 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 160 IS - 2 N2 - BACKGROUND: Concurrent infection with HIV and human papillomavirus (HPV) in women is associated with increased rates of cervical dysplasia and shorter survival following the development of cervical cancer. The authors examined risk factors for HPV infection at study entry in HIV-positive women enrolled in the Canadian Women's HIV Study, a prospective open cohort study. METHODS: Subjects eligible for this analysis included the 375 HIV-positive women in the Canadian Women's HIV Study for whom HPV test results were available. Questionnaires on behavioural and clinical information, Pap smears, cervicovaginal lavage specimens and vaginal tampon specimens for HPV detection and typing by polymerase chain reaction were obtained at study entry. RESULTS: Overall, 67.2% (252/375) of the women were HPV-positive; the global prevalence of intermediate- and high-risk oncogenic HPV types was 49.1% (184/375). Women with squamous cell dysplasia (32/294) were more likely to have HPV infection than those without dysplasia (90.6% v. 62.6%; p = 0.002). Multivariate logistic regression analysis, with adjustment for number of lifetime partners and history of STD, revealed that the following risk factors were independently associated with HPV infection: CD4 count of less than 0.20 x 10(9)/L (adjusted odds ratio [OR] 1.99 [95% confidence interval (Cl) 1.17-3.37 (p = 0.011)]), non-white race (adjusted OR 2.00 [95% Cl 1.17-3.42 (p = 0.011)]), inconsistent condom use in the 6 months before study entry (adjusted OR 2.02 [95% Cl 1.16-3.50 (p = 0.013)]), and lower age, with women age 30-39 years (adjusted OR 0.51 [95% Cl 0.30-0.87 (p = 0.013)]) and age 40 years or older (adjusted OR 0.52 [95% Cl 0.26-1.01 (p = 0.052)]) compared with women less than 30 years of age. INTERPRETATION: Close monitoring for HPV-related effects is warranted in all HIV-positive women, particularly younger, non-white women who do not always use condoms. Counselling for women living with HIV, particularly younger women, should emphasize the importance of regular cytological screening, with increasing frequency as the CD4 count falls. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/9951439/Prevalence_of_risk_factors_associated_with_human_papillomavirus_infection_in_women_living_with_HIV__Canadian_Women's_HIV_Study_Group_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=reprint&pmid=9951439 DB - PRIME DP - Unbound Medicine ER -