HPV genotype distribution in cervical intraepithelial neoplasia among HIV-infected women in Pune, India

Arati Mane, Amit Nirmalkar, Arun R Risbud, Sten H Vermund, Sanjay M Mehendale, Vikrant V Sahasrabuddhe, Arati Mane, Amit Nirmalkar, Arun R Risbud, Sten H Vermund, Sanjay M Mehendale, Vikrant V Sahasrabuddhe

Abstract

Background: The distribution of HPV genotypes, their association with rigorously confirmed cervical precancer endpoints, and factors associated with HPV infection have not been previously documented among HIV-infected women in India. We conducted an observational study to expand this evidence base in this population at high risk of cervical cancer.

Methods: HIV-infected women (N = 278) in Pune, India underwent HPV genotyping by Linear Array assay. Cervical intraepithelial neoplasia (CIN) disease ascertainment was maximized by detailed assessment using cytology, colposcopy, and histopathology and a composite endpoint.

Results: CIN2+ was detected in 11.2% while CIN3 was present in 4.7% participants. HPV genotypes were present in 52.5% (146/278) and 'carcinogenic' HPV genotypes were present in 35.3% (98/278) HIV-infected women. 'Possibly carcinogenic' and 'non/unknown carcinogenic' HPV genotypes were present in 14.7% and 29.5% participants respectively. Multiple (≥ 2) HPV genotypes were present in half (50.7%) of women with HPV, while multiple 'carcinogenic' HPV genotypes were present in just over a quarter (27.8%) of women with 'carcinogenic' HPV. HPV16 was the commonest genotype, present in 12% overall, as well as in 47% and 50% in CIN2+ and CIN3 lesions with a single carcinogenic HPV infection, respectively. The carcinogenic HPV genotypes in declining order of prevalence overall included HPV 16, 56, 18, 39, 35, 51, 31, 59, 33, 58, 68, 45 and 52. Factors independently associated with 'carcinogenic' HPV type detection were reporting ≥ 2 lifetime sexual partners and having lower CD4+ count. HPV16 detection was associated with lower CD4+ cell counts and currently receiving combination antiretroviral therapy.

Conclusion: HPV16 was the most common HPV genotype, although a wide diversity and high multiplicity of HPV genotypes was observed. Type-specific attribution of carcinogenic HPV genotypes in CIN3 lesions in HIV-infected women, and etiologic significance of concurrently present non/unknown carcinogenic HPV genotypes await larger studies.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Bar graphs showing HPV genotype…
Figure 1. Bar graphs showing HPV genotype prevalence by age categories among HIV-infected women in Pune, India.
HPV prevalence levels (as percentages) are displayed on the Y-axis, with various carcinogenicity groupings (any HPV type, carcinogenic HPV type, possibly carcinogenic HPV types, and non/unknown carcinogenic types) shown as individual bar graphs grouped by age categories (≤25, 26–30, 31–35, 36–40, & ≥41 years) on X-axis.
Figure 2. Bar graphs showing HPV genotype…
Figure 2. Bar graphs showing HPV genotype prevalence by CD4+ cell count categories among HIV-infected women in Pune, India.
HPV prevalence levels (as percentages) are displayed on the Y-axis, with various carcinogenicity groupings (any HPV type, carcinogenic HPV type, possibly carcinogenic HPV types, and non/unknown carcinogenic types) shown as individual bar graphs grouped by CD4+ count categories (≤199, 200–299, 300–399, 400–499, ≥500 /µL) on X-axis.

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Source: PubMed

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