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Epidemiology
Original research
Prevalence and risk factors for anogenital HPV infection and neoplasia among women living with HIV in China
  1. Rufei Duan1,
  2. Hongyun Zhang2,
  3. Aihui Wu3,
  4. Chongxi Li4,
  5. Le Li3,
  6. Xiaoqian Xu1,
  7. Youlin Qiao1,
  8. Fanghui Zhao1,
  9. Gary Clifford5
  1. 1 Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
  3. 3 Department of Gynaecology and Obstetrics, The Third People's Hospital of Kunming, Kunming, China
  4. 4 Department of Infectious Disease, The Third People's Hospital of Kunming, Kunming, China
  5. 5 International Agency for Research on Cancer, Lyon, France
  1. Correspondence to Professor Fanghui Zhao, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; zhaofangh{at}cicams.ac.cn

Abstract

Objectives To explore the prevalence and risk factors of anogenital human papillomavirus (HPV) infection and neoplasia among women living with HIV (WLHIV) in China.

Methods A cross-sectional survey was conducted from 2019 to 2020, 409 WLHIV aged 18 years and older were recruited from an HIV treatment clinic in Yunnan, China. Cervical and anal samples were collected for HPV testing of 15 HPV genotypes and cytological interpretation. Women positive for cervical HPV or cytological abnormalities were recalled for colposcopy examination and biopsy when necessary. Prevalence of anogenital HPV infection and neoplasia were compared by logistic regression.

Results HPV prevalence was 34.2% (140/409) for cervical and 34.7% (142/409) for anal (high-risk HPV being 30.6% (125/409) and 30.3% (124/409), respectively). The most frequent genotypes were HPV-52, HPV-16 and HPV-58 in the cervix, HPV-52, HPV-53 and HPV-39 in the anus, with strong correlation between cervical and anal positivity, both overall and at a type-specific level. Cervical HPV was most associated with short duration of combination antiretroviral therapies (cART) (≤2 vs >2 years, adjusted OR (aOR)=2.25, 95% CI: 1.22 to 4.12) and high initial HIV viral load (≥1000 vs <1000 copies/mL, aOR=1.98, 95% CI: 1.10 to 3.58). Anal HPV was most associated with low nadir CD4 count (<200 vs ≥200 cells/µL, aOR=1.80, 95% CI: 1.01 to 3.22) and low current CD4 count (<350 vs ≥500 cells/µL, aOR=2.06, 95% CI: 1.00 to 4.36). CIN2+ prevalence was 4.6% and associated with low nadir CD4 count (aOR=4.63, 95% CI: 1.24 to 17.25).

Conclusions Cervical and anal HPV were strongly correlated and, together with associated neoplasia, were highly prevalent among WLHIV in China. Early initiation of cART to avoid severe immunodeficiency should decrease anogenital HPV prevalence and related cancer burden among WLHIV. Incorporating anogenital cancer prevention services into HIV/AIDS care is warranted.

  • HIV
  • cervical intraepithelial neoplasia
  • diagnostic screening programs
  • infection
  • health promotion

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/sextrans-2021-055019

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Anna Maria Geretti

    • Contributors FZ was the study conception initiator and designed the study. RD, HZ, AW, CL, LL and XX were involved in data collection and assembly. RD and FZ participated in manuscript writing, data analysis and interpretation. GC and YQ provided constructive comments and revisions on the manuscript. All authors have reviewed and approved the final article.

    • Funding This study was financially supported by National Natural Science Foundation of China (81761128006), Chinese Academy of Medical Sciences Initiative for Innovative Medicine (2016-I2M-1–019), China Medical Board (16-255), and National Key R&D Program of China (2018YFC1315504).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.