HIV-1, HIV-2, and dual infection with HIV-1 and HIV-2 are associated with increased risk for human papillomavirus (HPV) and high grade squamous intraepithelial lesions (HSIL) in Senegal, West Africa

Abstract

We conducted a cross-sectional screening study of HIV-1 and HIV-2, human papillomavirus (HPV), and cervical intraepithelial lesions (SIL) in previously unscreened women in an outpatient infectious disease clinic in Dakar, Senegal. In addition, we conducted a prospective study of development of HSIL among women with HIV-1 and/or HIV-2 and HPV infection seen in that clinic and a sexually transmitted disease clinic serving commercial sex workers. Women infected with HIV-1 alone (OR = 7.3, 95% CI = 5.5--9.7), HIV-2 alone (OR = 4.7, 95% CI = 2.7--8.3), and coinfection with HIV-1 and HIV-2 (OR = 10.2, 95% CI = 4.3--24.4) were at significantly increased risk for prevalent infection with high risk HPV compared to women without HIV infection. Similarly, women infected with HIV-1 alone (OR = 3.7, 95% CI = 1.9--7.4), HIV-2 alone (OR = 7.1, 95% CI = 2.9--17.4), and coinfection with HIV-1 and HIV-2 (OR = 14.4, 95% CI = 4.2--50) were at increased risk for prevalent high grade squamous intraepithelial lesions (HSIL) compared to women without HIV infection. In the absence of high risk HPV, women with HIV infection were not at increased risk of HSIL. In women with HIV-1 and/or HIV-2 infection, increased HIV plasma RNA loads and decreased CD4 levels were significantly associated with high risk HPV detection and cervical abnormalities. HIV-positive women (with HIV-1, HIV-2 or HIV coinfection) were ten times as likely to have invasive cervical cancer identified by cytology or biopsy. In the longitudinal study, we followed 630 women over a mean of 2.2 years, during which 73 (11%) developed HSIL as detected by cytology. Among women without oncogenic HPV types detected, HIV positive and negative women were at similar risk for development of HSIL. Persistent infection with oncogenic HPV types (RR = 10.4, 95% CI = 4.1--26.3) was most strongly associated with HSIL risk. Among HIV positive women, those with low CD4 counts and high HIV plasma levels were at greater risk of HSIL, through persistence of their HPV infections. After adjustment for CD4 counts and HPV infection, women with HIV-1 and HIV-2 had similar risks for HSIL. In conclusion, HPV infected women with HIV-1 and/or HIV-2 especially those who are severely immunosuppressed, are at significantly increased risk for HSIL and invasive cancer.