TREAT Asia/amfAR-Foundation for AIDS Research.
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Clin Infect Dis. 2018 Aug 1;67(4):606-613. doi: 10.1093/cid/ciy144.
Infection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)-infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency.
PHIV and HU females aged 12-24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses.
Ninety-three PHIV and 99 HU adolescents (median age 19 [18-20] years) were enrolled (June 2013-July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392-808) cells/mm3, and 62% had a viral load <40 copies/mL. Across anogenital compartments, PHIV had higher rates of any HPV detected (80% vs 60%; P = .003) and any HR-HPV (60% vs 43%, P = .02). Higher proportions of PHIV had abnormal Pap smears (eg, atypical squamous cells of unknown significance [ASC-US], 12% vs 14%; low-grade squamous intraepithelial neoplastic lesions, 19% vs 1%). After adjusting for ever being pregnant and asymptomatic sexually transmitted infections (STI) at enrollment, PHIV were more likely to have HR-HPV than HU (odds ratio, 2.02; 95% confidence interval, 1.09-3.77; P = .03).
Perinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.
由于长期免疫缺陷，围产期感染人类免疫缺陷病毒（HIV）的高危型人乳头瘤病毒（HR-HPV）的可能性高于未感染 HIV 的青少年（PHIV）。
在泰国和越南，按照年龄组和终生性伴侣数，对 12-24 岁的 PHIV 和 HU 女性进行匹配。入组时，采集血液、宫颈、阴道、肛门和口腔样本进行 HPV 相关检测。采用 Wilcoxon 和 Fisher 精确检验进行单变量分析，logistic 回归进行多变量分析。
共纳入 93 名 PHIV 和 99 名 HU 青少年（中位年龄 19 岁[18-20 岁]）（2013 年 6 月-2015 年 7 月）。在 PHIV 中，94%正在接受抗逆转录病毒治疗，中位 CD4 计数为 593（392-808）个细胞/mm3，62%病毒载量<40 拷贝/ml。在所有肛门生殖器部位，PHIV 检测到 HPV 的比例更高（80% vs. 60%；P=0.003），HR-HPV 比例更高（60% vs. 43%，P=0.02）。PHIV 异常巴氏涂片的比例更高（例如，非典型鳞状细胞意义不明[ASC-US]，12% vs. 14%；低级别鳞状上皮内瘤变，19% vs. 19%）。在校正了入组时的怀孕和无症状性传播感染（STI）后，PHIV 比 HU 更有可能感染 HR-HPV（比值比，2.02；95%置信区间，1.09-3.77；P=0.03）。
围产期 HIV 感染与 HR-HPV 和异常宫颈细胞学的风险增加有关。我们的结果强调了为 PHIV 青少年接种 HPV 疫苗以及开展 HPV 和其他 STI 的预防和筛查计划的必要性。
