HIV Load and CD4+ Cell Count Affect HPV Detection in HIV-infected Women

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In HIV-infected women, the plasma HIV RNA level and the CD4+ cell count are strong determinants of the ability to detect human papillomavirus (HPV) on Pap smear, new research shows. This suggests that a weakening immune system may facilitate reactivation of HPV.

"Our data suggest that undetectable HPV infections become active much more frequently in HIV-positive women, which helps explain the extremely high rates of HPV infection in these women," lead author Dr. Howard D. Strickler, from the Albert Einstein College of Medicine in New York, said in a statement.

"By extension, our findings suggest that HIV-positive women and other women with poor immune status, such as transplant patients, may benefit from continued cervical screening even if they've long been celibate, since old HPV infections can rise again," he added.

Dr. Strickler's team analyzed data from 1848 HIV-positive and 514 HIV-negative women to assess factors that influence HPV detection. The findings are published in the April 20th issue of the Journal of the National Cancer Institute.

The HIV RNA level and the CD4+ cell count were strongly linked to both prevalent and incident HPV detection. The highest odds of detecting HPV were seen with HIV RNA levels > 100,000 copies/mL and CD4+ cell counts of < 200 cells/mL. The likelihood of detecting squamous intraepithelial lesions showed a similar association with HIV RNA level and CD4+ cell count.

The number of recent sexual partners was directly related to incident HPV detection in all women. However, 22% of sexually inactive HIV-infected women with low CD4+ cell counts still had at least one incidently detected HPV type.

The association between HIV coinfection and HPV persistence was more moderate, which could help explain why epidemic proportions of cervical cancer are not yet seen in HIV-infected women, the authors point out.

04/20/05