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Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer

Keller, Marla J.a; Burk, Robert D.a; Massad, L. Stewartb; Eltoum, Isam-Eldinc; Hessol, Nancy A.d; Anastos, Kathryna; Xie, Xianhonga; Minkoff, Howarde; Xue, Xiaonana; Reimers, Laura L.f; Kuniholm, Markg; D'Souza, Gypsyamberh; Colie, Christinei; Aouizerat, Bradleyj; Palefsky, Joel M.d; Strickler, Howard D.a

doi: 10.1097/QAD.0000000000002005

Objective: Recent studies reported a lower human papillomavirus 16 (HPV16) prevalence in cervical precancer among African American than Caucasian women in the general population. We assessed this relationship in women with HIV.

Design: Women living with or at risk for HIV in the Women's Interagency HIV Study were followed semi-annually with Pap tests, colposcopy/histology (if indicated), and collection of cervicovaginal lavage samples for HPV testing by PCR. Racial and ethnic groups were defined using genomic Ancestry Informative Markers (AIMs).

Results: Among 175 cases of cervical intraepithelial neoplasia 3 or worse (CIN-3+), 154 were diagnosed in women with HIV. African American (27%) and Hispanic (37%) cases were significantly less likely than Caucasian (62%) women to test positive for HPV16 (P = 0.01). In multivariate logistic regression models, these associations remained significant for African Americans (odds ratio = 0.13; 95% confidence interval (CI) 0.04–0.44; P = 0.001) but not Hispanics, after controlling for HIV status, CD4+ count, history of AIDS, age, smoking, and sexual behavior. Limiting the analysis to women with HIV did not change the findings.

Conclusion: HPV16 prevalence is lower in African American compared with Caucasian women with HIV and cervical precancer, independent of immune status. Future studies to determine why these racial differences exist are warranted, and whether there are similar associations between race and invasive cervical cancer in women with HIV. Further, HPV types not covered by quadrivalent and bivalent vaccines may play an especially important role in cervical precancer among HIV-positive African American women, a possible advantage to using nonavalent HPV vaccine in this population.

aDepartment of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York

bWashington University School of Medicine, St. Louis, Missouri

cUniversity of Alabama at Birmingham, Birmingham, Alabama

dUniversity of California San Francisco, San Francisco, California

eMaimonides Medical Center, Brooklyn

fPfizer, New York

gUniversity at Albany-State University of New York, Albany, New York

hJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

iGeorgetown University Medical Center, Washington, DC

jNew York University College of Dentistry, New York, New York, USA.

Correspondence to Dr Marla J. Keller, MD, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Block Building, Room 512, Bronx, NY 10461, USA. Tel: +1 718 430 3240; fax: +1 718 430 8879; e-mail:

Received 21 June, 2018

Accepted 13 August, 2018

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