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.
- cervical intraepithelial neoplasia
- diagnostic screening programs
- health promotion
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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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.