Prevalent and Persistent Oncogenic HPV Types in a Cohort of Women Living with HIV Prior to HPV Vaccination McClymont, Elisabeth; Lee, Marette; Raboud, Janet; Coutlée, François; Walmsley, Sharon; Lipsky, Nancy; Loutfy, Mona; Trottier, Sylvie; Smaill, Fiona; Klein, Marina B.; Harris, Marianne; Cohen, Jeffrey; Yudin, Mark H.; Wobeser, Wendy; Money, Deborah M.
Objective: To describe prevalent and persistent oncogenic HPV types detected in women living with HIV (WLWH) in Canada, including in women with cervical dyskaryosis, and to determine predictors of type-specific HPV persistence. Methods: 252 women were eligible for this sub-analysis of a prospective vaccine immunogenicity cohort study (2 HPV DNA results, ≥1 cervical cytology result pre vaccination). Demographic and clinical data were collected alongside cervical samples for cytology and HPV DNA typing between 2008-2015. Results: Pre-vaccination, HPV16 and HPV52 were the most prevalent oncogenic HPV types. Forty-five percent of participants were infected with ≥1 oncogenic HPV type and one-third of participants had a persistent oncogenic infection. HPV16, 45, and 52 were the most frequently persistent types. Seventeen percent of women had persistent infections with oncogenic HPV types not within currently available vaccines (HPV35/39/51/56/59/68/82). Lower CD4 count significantly predicted HPV persistence (p=0.024). Cervical cytology was 82.9% normal, 2.4% atypical squamous cells of undetermined significance, 11.5% low-grade squamous intraepithelial lesions, and 2.8% high-grade squamous intraepithelial lesions. Conclusion: Unvaccinated WLWH were infected with a wide range of oncogenic HPV types. Our findings highlight the importance of optimal HIV treatment and continued cervical cancer screening as key steps towards global elimination of cervical cancer.
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