Aim: The high risk of HPV-related cancers in HIV/AIDS-patients, even under HAART treatment, stimulated our studies on HPV-distribution analyse, as well as on persistence and changes in HPV multiplicity of infections before and during antiretroviral treatment.
Materials and Methods: Prevalence and persistence of mucosal HPV genotypes and HPV16 variants were analysed in a prospective cohort of HIV-positive Italian women along with control population.
Results: HIV-positive women were more likely than HIV-negative women to be infected by HPV at the first examination ( P<0.001) and to have a higher period-prevalence of HPV infection over a 3-year follow-up (P<0.001), regardless of CD4+ cell counts and anti-retroviral therapy. ‘High-risk’ and ‘probable high-risk’ HPVs were predominant in HIV-positive (33.9 %) compared with HIV-negative (13.9 %) women. Among HIV-infected women, with normal cytology as well as with SIL of any grade, the most common genotypes were HPV16 followed by HPV81, -58, -72, -33 and -62. HPV16 isolates from 18 HIV-positive and eight HIV-negative women were classified into variant lineages based on sequencing analysis of the Long Control Region and E6/E7 genes. Whilst the HPV16 G350 European variant was prevalent in both HIV-positive (10.7 %) and -negative women (3.5 %), HPV16 African 2 variants were only detected in HIV-positive women (3.6 %), suggesting different sexual mixing behaviours.
Discussion: The high prevalence of HPV-related lesions in our cohort study of HIV-positive patients under HAART-treatment, is consistent with the reported high standardized incidence rates (SIRs) of HPV-related in situ cervical (SIR 8.9, 95% CI = 8.0-9.9) and anal cancers (SIR 68.6, 95% CI = 59.7-78.4) as well as for invasive oropharyngeal (SIR 1.6, 95% CI = 1.2-2.1). The high prevalence of uncommon viral genotypes and HPV16 variants in HIV-positive women underscores the need for wide-range HPV typing in cervical smears of this population.