HPV infection in HIV-positive females: the need for cervical cancer screening including HPV-DNA detection despite successful HAART

PURPOSE: To identify the presence of Human Papilloma Virus (HPV) infection and
evaluate the role of Highly Active Antiretroviral Treatment (HAART) in patients
with HIV-HPV co-infection. We also compared cytological screening results with
HPV-DNA detection to implement screening programs and prevention of invasive
cervical cancer (ICC) in HIV-infected females.
PATIENTS AND METHODS: We enrolled HIV-infected females presenting for routine
clinical evaluation. HPV-DNA of high/intermediate and low-risk types was detected
from cervical specimens by nucleic acid hybridization assay with
signal-amplification. Patients were divided into two groups according to the
presence of HPV co-infection (HPV+) or not (HPV-).
RESULTS: We enrolled 57 HIV-infected females. Median age was 40 (IQR 35-44)
years, mean CD4 count was 547 ± 227 cells/mm(3), 45 (78.9%) had undetectable
HIV-RNA and 52 (91.2%) received HAART. Globally, 19/57 (33.3%) patients were
HPV-infected, 16/57 (28.1%) with high/intermediate and 3/57 (5.3%) with low-risk
types. Five of the 19 (26.3%) HPV+ patients carried both types. Correlating
high-risk genotype HPV-DNA detection with cytology, 17.5% of women with negative
cytology, 36.4% with ASCUS (Atypical Squamous Cells of Uncertain Significance)
and 83.4% of women with positive cytology (50% of LSIL: low-grade squamous
intraepithelial lesion and 100% of HSIL: high grade SIL) were HPV positive. No
statistical difference when comparing HPV+ and HPV-patients in age, CD4 cell
count, in the proportion of previous intravenous-drug use, previous AIDS and of
those receiving HAART with undetectable HIV-RNA was observed.
CONCLUSIONS: Cervical cancer screening including HPV-DNA detection should be
implemented in HIV infected females across Europe, also when receiving successful
HAART, to early identify the HIV patients at risk for ICC to be submitted to more
frequent follow up and proper treatment.