Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels Free University, Brussels, Belgium.
J Int AIDS Soc. 2013 Feb 14;16(1):18023. doi: 10.7448/IAS.16.1.18023.
Cervical infection with high-risk human papillomavirus (HRHPV) induces cervical cancer and is present in 14% of women in Europe. We assessed the prevalence and incidence of cervical HRHPV in a cohort of HIV-positive women living in Belgium.
Prospective observational program of screening and follow up of HRHPV cervical infection performed by Hybrid Capture in 825 HIV-positive women between 2002 and 2011. Women without normal cervix at baseline were excluded.
The final analysis included 652 women: median age 38 years, African origin (81%), median HIV follow-up (66 months), median CD4 count (426 cells/μL) and 79% on antiretroviral therapy (cART). At baseline, HRHPV prevalence was 43% and decreased significantly as both age and CD4 cell count increased: highest prevalence (100%) in women <30 years and <200 CD4/μL and lowest (19%) in women >40 years and >500 CD4/μL (p<0.0001, multivariate analysis). The relative risk (RR) to carry HRHPV at baseline decreases proportionally by 11% for each 5 years-age increase and by 11% for each 100 CD4 cells/μL rise (RR=0.89, 95% CI: 0.85-0.93; p<0.0001, Poisson regression for both). During follow-up, incidence rate of HRHPV was 13.4 per 100 women-years.
We found a high HRHPV prevalence of 43% and an incidence rate of 13 per 100 women-years in this cohort of HIV-positive women living in Europe and on cART. Women under 40 years-age had the highest prevalence even with CD4 count >350 cells/μL. The magnitude of HRHPV epidemiology should prompt to evaluate the clinical efficacy of vaccines against HPV in HIV-infected women.
高危型人乳头瘤病毒（HRHPV）引起的宫颈感染可导致宫颈癌，在欧洲约 14%的女性中存在。我们评估了生活在比利时的 HIV 阳性女性队列中宫颈 HRHPV 的流行率和发病率。
2002 年至 2011 年间，通过杂交捕获对 825 名 HIV 阳性女性进行了前瞻性观察性筛查和 HRHPV 宫颈感染随访。未在基线时出现正常宫颈的女性被排除在外。
最终分析包括 652 名女性：中位年龄 38 岁，非洲裔（81%），中位 HIV 随访时间（66 个月），中位 CD4 计数（426 个细胞/μL），79%接受抗逆转录病毒治疗（cART）。基线时，HRHPV 流行率为 43%，且随年龄和 CD4 细胞计数增加而显著降低：年龄<30 岁且 CD4/μL<200 的女性中最高（100%），年龄>40 岁且 CD4/μL>500 的女性中最低（19%）（p<0.0001，多变量分析）。基线时携带 HRHPV 的相对风险（RR）随着年龄每增加 5 岁而相应降低 11%，随着每增加 100 CD4 细胞/μL 而降低 11%（RR=0.89，95%CI：0.85-0.93；p<0.0001，泊松回归，两者均适用）。随访期间，HRHPV 发病率为每 100 名女性-年 13.4 例。
我们发现，在生活在欧洲且接受 cART 的 HIV 阳性女性队列中，HRHPV 流行率为 43%，发病率为每 100 名女性-年 13 例。即使 CD4 计数>350 个细胞/μL，年龄<40 岁的女性仍具有最高的流行率。HRHPV 流行病学的规模应促使我们评估 HPV 疫苗在 HIV 感染女性中的临床疗效。
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