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Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study
  1. Qian Wang1,
  2. Xiaomeng Ma2,3,
  3. Xiaosong Zhang4,
  4. Jason J Ong5,
  5. Jun Jing3,
  6. Lei Zhang6,7,8,9,
  7. Lin-Hong Wang10,11
  1. 1 National Center for Women and Children’s Health, China Center for Disease Control, Beijing, China
  2. 2 Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3 Research Center for Public Health School of Medicine, Tsinghua University, Beijing, China
  4. 4 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
  5. 5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  6. 6 Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
  7. 7 School of Public Health and Preventive Medicine Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  8. 8 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  9. 9 Nursing and Health Sciences Faculty of Medicine, Monash University Central Clinical School, Melbourne, Victoria, Australia
  10. 10 National Center for Chronic and Non-communicable Disease Control and Prevention, China Center for Disease Control, Beijing, China
  11. 11 Branch of Women Health, Chinese Preventive Medicine Association, Beijing, China
  1. Correspondence to Professor Lin-Hong Wang, Maternal and Child Healthcare Center, Chinese Center for Disease Control and Prevention, Beijing 100081, China; linhong{at}; Dr Lei Zhang, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China; lei.zhang1{at}


Objective Women living with HIV (WLHIV) face disproportionately higher risks of acquiring human papillomavirus (HPV) compared with HIV negative counterparts. We aimed to investigate the prevalence of HPV in WLHIV in Chinese hospital setting and identify associated factors to the progression of late-stage cervical intraepithelial neoplasia (CIN2+) in this population.

Method This retrospective study collected data from 183 WLHIV on antiretroviral treatment (ART), based on reproductive health questionnaires. Gynaecological examination results including serum (for HIV viral load, CD4 T-cell count, hepatitis B infections, syphilis) and vaginal swabs for common bacterial sexually transmitted infections (STIs). Multivariate-logistic regression was applied to analyze the contributing factors to CIN2+.

Results HIV coinfection with other Sexually Transmitted Infections (STIs) were observed in 99 participants (54.1%, (99/183)). HPV (43.7% (80/183)) was the most prevalent STI. The three most prevalent HPV subtypes were all high-risk HPV (HR-HPV), including HPV52 (33.8% (27/80)), HPV58 (21.3% (17/80)) and HPV33 (13.75% (11/80)). About a third (37.5%, 30/80) of women with HPV had HR-HPV. Multiple HPV coinfections were common in HIV-HPV coinfected women (41.3%, 33/80). Cytological examinations revealed that 77.5% (62/80) HPV+ women had detectable cervical lesions. In comparison, only 4.9% (5/103) HPV negative womenwith Atypia and 1.0% (1/103) with CIN1 were diagnosed. Multivariate logistic regression revealed that HPV16 (OR=19.04, 2.53 to 122.92; p=0.004) and HPV18 (OR=11.54, 1.45 to 91.64; p=0.021) infections were significantly associated with CIN2+ in HIV-HPV coinfected women.

Conclusion A high prevalence of HPV was found in women on ART. HPV16/18 infection are strong associated factors to CIN2+ in HIV-HPV coinfected women.

  • HIV
  • HPV
  • cervical neoplasia
  • women

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  • LZ and L-HW are joint senior authors.

  • QW and XM contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors The original data of participants were collected and proofread by XZ. QW and XM cleaned the data and performed preliminary statistical analysis. JJO, LZ and LW offered contributing suggestions in improving analysis from clinical and epidemiological perspectives. QW and XM collated the study results and wrote the first version of draft, which then was modified by JJ, JJO, LZ and LW for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Institutional Review Board Tsinghua University Research Centre for Public Health approved this study (Approval No. 009).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Original data are available and can be accessed by contacting Linhong Wang. All the patient records were deidentified before obtained for analysis. The analysis outcomes of all available data were reported in the article.