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Concomitant anal and cervical human papillomavirusV infections and intraepithelial neoplasia in HIV-infected and uninfected women

Hessol, Nancy A.a; Holly, Elizabeth A.a; Efird, Jimmy T.b; Minkoff, Howardc; Weber, Kathleen M.d; Darragh, Teresa M.a; Burk, Robert D.e; Strickler, Howard D.e; Greenblatt, Ruth M.a; Palefsky, Joel M.a

doi: 10.1097/QAD.0b013e3283601b09
Clinical Science

Objective: To assess factors associated with concomitant anal and cervical human papillomavirus (HPV) infections in HIV-infected and at-risk women.

Design: A study nested within the Women's Interagency HIV Study (WIHS), a multicenter longitudinal study of HIV-1 infection in women conducted in six centers within the United States.

Methods: Four hundred and seventy HIV-infected and 185 HIV-uninfected WIHS participants were interviewed and examined with anal and cervical cytology testing. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV testing. Women with abnormal cytologic results had colposcopy or anoscopy-guided biopsy of visible lesions. Logistic regression analyses were performed and odds ratios (ORs) measured the association for concomitant anal and cervical HPV infection.

Results: One hundred and sixty-three (42%) HIV-infected women had detectable anal and cervical HPV infection compared with 12 (8%) of the HIV-uninfected women (P < 0.001). HIV-infected women were more likely to have the same human papillomavirus (HPV) genotype in the anus and cervix than HIV-uninfected women (18 vs. 3%, P < 0.001). This was true for both oncogenic (9 vs. 2%, P = 0.003) and nononcogenic (12 vs. 1%, P < 0.001) HPV types. In multivariable analysis, the strongest factor associated with both oncogenic and nononcogenic concomitant HPV infection was being HIV-infected (OR = 4.6 and OR = 16.9, respectively). In multivariable analysis of HIV-infected women, CD4+ cell count of less than 200 was the strongest factor associated with concomitant oncogenic (OR = 4.2) and nononcogenic (OR = 16.5) HPV infection.

Conclusion: HIV-infected women, particularly those women with low CD4+ cell counts, may be good candidates for HPV screening and monitoring for both cervical and anal disease.

aUniversity of California, San Francisco, California

bCenter for Health Disparities Research, Brody School of Medicine, Greenville, North Carolina

cMaimonides Medical Center, SUNY Downstate, Brooklyn, New York

dThe Core Center, Cook County Health and Hospital System, Chicago, Illinois

eAlbert Einstein College of Medicine, Bronx, New York, USA.

Correspondence to Nancy A. Hessol, University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, Suite 420, San Francisco, CA 94143–0613, USA. Tel: +1 415 476 3848; fax: +1 415 502 0792; e-mail:

Received 27 November, 2012

Revised 8 February, 2013

Accepted 12 February, 2013

An earlier version of this study was presented at the 24th International Papillomavirus Conference and Clinical Workshop, Beijing, China, 3–9 November, 2007.

© 2013 Lippincott Williams & Wilkins, Inc.