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Prevalence and Risk Factors for HPV in HIV-Positive Young Women Receiving Their First HPV Vaccination

Kahn, Jessica A. MD, MPH*; Burk, Robert D. MD; Squires, Kathleen E. MD; Kapogiannis, Bill G. MD§; Rudy, Bret MD; Xu, Jiahong MS, MPH; Gonin, René PhD; Liu, Nancy MPH; Worrell, Carol MD§; Wilson, Craig M. MD#

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2012 - Volume 61 - Issue 3 - p 390–399
doi: 10.1097/QAI.0b013e3182676fe3
Epidemiology and Prevention

Background: The objectives of this study were to describe the prevalence and risk factors for HPV infection among HIV-infected young women receiving their first quadrivalent HPV (HPV-6, -11, -16, and -18) vaccine dose.

Methods: We recruited 16- to 23-year-old women from 14 sites for an HPV vaccine trial. At the first visit, they completed a questionnaire and were tested for cervicovaginal HPV DNA (41 types) and HPV serology (4 vaccine types). Factors associated with any HPV, type-specific HPV, and high-risk (cancer-associated) HPV infections were identified using univariate and multivariable logistic regression.

Results: The mean age of participants (N = 99) was 21.4 years, 30.3% were on antiretroviral therapy, 74.7% were positive for ≥1 HPV DNA type, 53.5% for ≥1 high-risk type, 12.1% for HPV-16, and 5.1% for HPV-18. Most were HPV DNA negative and seronegative for HPV-16 (55.6%) and HPV-18 (73.7%); 45.5% were HPV DNA negative and seronegative for both HPV-16 and -18. Three variables were associated with high-risk HPV DNA in multivariable analysis: non-Hispanic black versus Hispanic ethnicity (adjusted odds ratio [AOR]: 7.06, 95% CI: 1.63 to 30.5), HIV viral load ≥ 400 versus <400 copies/mL (AOR: 3.47, 95% CI: 1.28 to 9.43), and frequency of vaginal sex in the past 90 days (AOR: 5.82, 95% CI: 1.30 to 26.11 for ≥6 vs 0 times).

Conclusions: The prevalence of ≥1 HPV type was high in these young women, demonstrating the importance of vaccinating before sexual initiation. However, most women were HPV DNA negative and seronegative for high-risk vaccine-type HPV infection, supporting vaccination of sexually experienced HIV-positive young women.

*Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH

Departments of Pediatrics, Microbiology and Immunology, Obstetrics and Gynecology and Women's Health, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY

Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA

§Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD

||Department of Pediatrics, New York University School of Medicine, New York, NY

Westat, Rockville, MD

#Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL.

Correspondence to: Jessica A. Kahn, MD, MPH, Division of Adolescent Medicine, MLC 4000, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 (e-mail:

Supported by The Adolescent Trials Network for HIV/AIDS Interventions from the National Institutes of Health (NIH) Grants U01 HD 040533 and U01 HD 040474 through the National Institute of Child Health and Human Development (B. G. Kapogiannis and C. Worrell). Vaccine and HPV Mean Geometric Titers were provided through the Investigator-Initiated Studies Program of Merck & Co, Inc. In addition, R. D. Burk used core facilities of the Einstein–Montefiore Center for AIDS supported by the NIH Grant AI-51519 and the Einstein Cancer Research Center Grant P30CA013330 from the National Cancer Institute. Two of the sites used their General Clinical Research Center/Pediatric Clinical Research Center for the study. The centers were supported by grants from the General Clinical Research Center Program of the National Center for Research Resources, NIH, Department of Health and Human Services as follows: Children's National Medical Center Grant M01RR020359 and University of Pennsylvania/Children's Hospital of Philadelphia Grant NCRRUL1-RR-024134. The site at Tulane University Health Sciences Center used its Clinical and Transnational Research Center for the study; the center was supported in whole or in part by funds provided through the Louisiana Board of Regents RC/EEP (RC/EEP–06).

Presented in part at the 2nd International Workshop on Women and HIV, January 9, 2012, Bethesda, MD.

Drs J. A. Kahn and B. Rudy are the co-chairs of another HPV vaccine clinical trial in HIV-positive individuals, for which Merck & Co, Inc, is providing vaccine and immunogenicity titers. Dr J. A. Kahn chaired a grant review committee for the Society for Adolescent Health and Medicine evaluating public health demonstration project proposals to improve adolescent vaccination; grant funding for this program was from Merck & Co, Inc. Dr K. E. Squires has served as a consultant and on the Advisory Board for Merck.

Received February 28, 2012

Accepted June 26, 2012

© 2012 Lippincott Williams & Wilkins, Inc.