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Prevalence of and Risks for Cervical Human Papillomavirus Infection and Squamous Intraepithelial Lesions in Adolescent Girls
Impact of Infection With Human Immunodeficiency Virus
Anna-Barbara Moscicki, MD;
Jonas H. Ellenberg, PhD;
Sten H. Vermund, MD, MPH;
Christie A. Holland, PhD;
Teresa Darragh, MD;
Peggy A. Crowley-Nowick, PhD;
Linda Levin, MD;
Craig M. Wilson, MD
Arch Pediatr Adolesc Med. 2000;154:127-134.
Context Data suggest that in adults, human papillomavirus (HPV) infections and their sequalae, squamous intraepithelial lesions (SILs), occur more commonly among human immunodeficiency (HIV)–infected women because of the HIV-associated CD4+ T-cell immunosuppression. Since adolescents are more likely to be early in the course of HIV and HPV infections, the study of both infections in this age group may help elucidate their initial relationship.
Objective To examine the prevalence of and risks for cervical HPV infection and SILs by HIV status in a population of adolescent girls.
Participants Subjects recruited at each of the 16 different US sites participating in a national study of HIV infection in adolescents.
Main Outcome Measures Cervical HPV DNA findings using polymerase chain reaction detection techniques and Papanicolaou smear from baseline visits. Infection with HPV was categorized into low- (rarely associated with cancer) and high- (commonly associated with cancers) risk types.
Results Of 133 HIV-infected girls, 103 (77.4%) compared with 30 (54.5%) of 55 noninfected girls were positive for HPV (relative risk [RR], 1.4; 95% confidence interval [CI], 1.1-1.8). The risk was for high-risk (RR, 1.8; 95% CI, 1.2-2.7) but not low-risk (RR, 1.2; 95% CI, 0.4-3.9) HPV types. Among the girls with HPV infection, 21 (70.0%) of the non–HIV-infected girls had normal cytologic findings compared with only 29 (29.9%) of the HIV-infected girls (P<.001). Multivariate analysis showed that HIV status was a significant risk for HPV infection (odds ratio [OR], 3.3; 95% CI, 1.6-6.7) and SIL (OR, 4.7; 95% CI, 1.8-14.8), but CD4 cell count and viral load were not associated with infection or squamous intraepithelial lesions. Only 9 girls had a CD4+ T-cell count of less than 0.2 cell x 109/L.
Conclusions High prevalence of HPV infection in both groups underscores the risky sexual behavior in this adolescent cohort. Rates of HPV infection and SILs were higher among HIV-infected girls, despite similar sexual risk behaviors and the relatively healthy state of our HIV-infected group. Infection with HIV may enhance HPV proliferation through mechanisms other than CD4 immunosuppression, particularly early in the course of HIV infection.
From the Departments of Pediatrics (Dr Moscicki) and Anatomic Pathology (Dr Darragh), University of California, San Francisco; Biostatistics, Westat Inc, Rockville, Md (Dr Ellenberg); the Departments of Medicine (Dr Vermund) and Pediatrics (Dr Wilson), Center for Virology, Immunology, and Infectious Diseases, University of Alabama at Birmingham; Children's Medical Center, Washington, DC (Dr Holland); The Fearing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Dr Crowley-Nowick); and Department of Pediatrics, Mt Sinai Medical Center, New York, NY (Dr Levin).
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