Understanding the pattern and prevalence of human papillomavirus (HPV) coinfection in women with HIV may provide insight into future vaccination programs and help establish routine cervical cancer screening protocols, according to a poster that was presented at American Society of Microbiology (ASM) Microbe 2019, held June 20 to 24 in San Francisco, California.

There is an increased risk of developing HPV in patients who are immunocompromised, as in the case of preexisting HIV. In addition, HPV coinfection further enhances the risk for cervical cancer. Although women infected with HIV are a high-risk group for HPV coinfection, the current pattern and prevalence of HPV infection in this population of Nepalese women has remained unexplored. Understanding the current pattern of prevalence of HPV infection in women with HIV can aid in guiding priority age groups for HPV vaccination in resource-limited areas, characterize HPV substrains among HIV-positive women, help establish routine cervical cancer screening, and document the effectiveness of visual inspection with acetic acid. Therefore, using visual inspection with acetic acid and real-time polymerase chain reaction-based detection of 14 high-risk HPV strains after colposcopy and biopsy, researchers evaluated the positivity of the former test.

In total, 786 women who were infected with HIV and enrolled in the National HIV Program under Sukraraj (Teku) Hospital were included in the study, regardless of CD4 count. Of the included women, 42.2% were positive for HPV, and among these positive cases, 59.51% had a single HPV strain and 19.93% had 2 HPV strains. Further, 3 women who were positive for the virus were positive for 6 HPV strains, and 1 woman had 7 strains of HPV.

The most prevalent strain was HPV-16 (32.0% of cases), which was followed by other high-risk strains including HPV-18, HPV-52, HPV-58, and HPV-51. When compared with older women (aged ≥25 years), younger women (aged 18-24 years) were more likely to be infected with HPV (31.4% vs 69.6% positive cases). Although most respondents were identified as negative in visual inspection with acetic acid screening, 16.4% were reported as positive in screening; 8% of women with HIV/AIDS were both HPV-positive and visual inspection with acetic acid-positive. Researchers highlighted that cancer development was 11-fold more likely in women with HPV and visual inspection with acetic acid compared with women without either (adjusted odds ratio, 11.1; 95% CI, 6.3-19.7).

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Overall, the study authors concluded that, “These findings played a greater role in efforts to extend HPV vaccine coverage in Nepal and could also be useful in formulation vaccination programmes in other resource-limited countries with high HPV/HIV prevalence.”

Reference

Awasthi NP, Nepal R, Bhattarai S, Dhakal B, Shrestha N, Pradhan SM, Rajbhadari RM, Dixit SM. HPV screening of HIV-infected women in Nepal suggest younger women are at higher risk of HIV/HPV co-infection. Presented at: ASM Microbe 2019; June 20-24, 2019; San Francisco, California. Poster S071.