Predictors of HPV incidence and clearance in a cohort of Brazilian HIV-infected women

• Published in: PloS one 2017-10, Vol.12 (10), p.e0185423-e0185423
• Main Authors: Travassos, Ana Gabriela, Netto, Eduardo, Xavier-Souza, Eveline, Nóbrega, Isabella, Adami, Karina, Timbó, Maiara, Abbehusen, Karen, Fernandes, Sheyla, Duran, Camila, Haguihara, Tatiana, Ferreira, Fábio, Brites, Carlos
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Alphapapillomavirus - physiology; Analysis; Antiretroviral drugs; Biology and Life Sciences; Brazil - epidemiology; Cancer; CD4 antigen; Cell cycle; Cell number; Cervical cancer; Cervix; Chlamydia; Cytology; Deoxyribonucleic acid; Development and progression; DNA; Epidemiology; Female; Gynecology; Health aspects; Health risks; HIV; HIV Infections - complications; Human immunodeficiency virus; Human papillomavirus; Humans; Immune response; Immunology; Incidence; Infections; Lesions; Load distribution; Lymphocytes T; Medical diagnosis; Medical screening; Medicine and Health Sciences; Oxidative stress; Papillomavirus infections; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Papillomavirus Infections - virology; Persistent infection; Prevalence; Prospective Studies; Risk analysis; Risk factors; Sexually transmitted diseases; STD; Studies; Vaccines; Women; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0185423

Persistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher rate of persistent infections and an earlier progression to cancer. We aimed to evaluate HR-HPV prevalence, incidence and clearance, and its association with HIV viral suppression, immunological response and other risk factors among WLHA followed at an STD/HIV reference center. This was a cohort study conducted at a reference center for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months after enrolment, where socio-epidemiological data were obtained. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS® Roche) in addition to blood samples for CD4+ T lymphocyte count and HIV viral load. We prospectively evaluated 333 women. HR-HPV DNA prevalence was 33.3% at baseline. HPV-16 was present in 5.1%, HPV-18 in 3.9% and 29.4% WLHA had other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). The HR-HPV incidence during the follow-up was 10.8%, at the 6-month visit was 7.7% and at the 12-month visit was 3.7%. Variables associated with HR-HPV incidence were: nulliparity, combined oral contraceptive use and detectable HIV viral load. The HR-HPV clearance rate was 41.7% and was associated with age >30 years and lymphocyte T CD4 count >500 cells/mm3 at enrolment. These findings contribute to the knowledge about a group of women that need more careful HPV screening and describe the association between an efficient immunological response and HIV viral suppression with lower incidence and increased clearance of HR-HPV.