Increased Risk of Cervical Abnormalities Among HIV-Infected African Women
In a study in Malawi, HIV-infected women were three times more likely than uninfected women to have persistent human papillomavirus infections (HPV), and twice as likely to have cervical abnormalities, according to NIAID-supported investigators and their colleagues. HPV infection is causally associated with cervical cancer, the most common malignancy among women in the developing world. Scientists estimate that worldwide 500,000 new cases of cervical cancer and 300,000 related deaths occur annually.
As reported in the March 1996 Journal of Infectious Diseases, the researchers found squamous epithelial lesions in 15 percent of 116 HIV-positive women, and 7 percent of 152 HIV-negative women. This heightened occurrence of cervical lesions probably resulted from a greater overall frequency of HPV infections (48 percent vs. 23 percent) in the HIV-positive group, write Paolo G. Miotti, M.D., of NIAID's Division of AIDS, Keerti V. Shah, M.D., of The Johns Hopkins University School of Hygiene and Public Health, and their colleagues.
Two high-risk types of HPV associated with cervical cancer -- HPV-16 and HPV-18 -- accounted for half of the HPV types identified in the study.
HIV-positive women were three times more likely than HIV-negative women to have an HPV infection that persisted from a first clinic visit to a second visit a year later. The most immunosuppressed women -- those with fewer than 300 CD4+ T cells/mm3 -- were most likely to have persistent HPV infections.
The strong correlation between HPV detection and immunosuppression levels suggests that HIV-induced immunosuppression may increase the susceptibility to HPV infection, its reactivation or duration," the authors write.
Previous studies have shown that HIV-infected women in the United States and Europe have elevated rates of HPV infection, cervical abnormalities and cervical cancer. In sub-Saharan Africa, however, data about the association between HIV, HPV and cervical abnormalities are largely lacking.
This study adds to growing evidence that early detection of HPV and regular monitoring of HPV-related cervical lesions are especially important in HIV-infected women, in developing as well as developed countries," says Penny Hitchcock, D.V.M., chief of the sexually transmitted diseases branch of NIAID's Division of Microbiology and Infectious Diseases.--Greg Folkers