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Relationship of Pregnancy to Human Papillomavirus Among Human Immunodeficiency Virus–Infected Women

From the¹ Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, Brooklyn, New York; ²Clinical Trials & Surveys Corp., Baltimore, Maryland; ³Pediatric, Adolescent and Maternal Acquired Immunodeficiency Syndrome (AIDS) Branch, National Institute of Child Health and Human Development, Bethesda, Maryland; ⁴Department of Internal Medicine, University of Illinois, Chicago, Illinois; ⁵Department of Medicine, University of California at San Francisco, San Francisco, California; ⁶Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts; ⁷Department of Pediatrics, Columbia University, New York, New York; ⁸Department of Obstetrics and Gynecology, University of Puerto Rico Pediatric, Can Juan, Puerto Rico; ⁹Department of Family and Community Medicine and in the Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and ¹⁰Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.*

OBJECTIVE: Because parity is a reported risk factor for cervical cancer, we sought to estimate the effects of pregnancy on the prevalence, incident detection, and copy number of human papillomavirus (HPV) among human immunodeficiency virus (HIV)–infected women, patients at high risk for cervical cancer.

METHODS: Human immunodeficiency virus–infected women who had a pregnancy in the Women’s Interagency HIV Study (n=178) and the Women and Infants Transmission Study (n=450) underwent serial type-specific HPV DNA testing using MY09/MY11 polymerase chain reaction. During pregnancy and during the prepregnancy and postpregnancy periods, we assessed HPV prevalence, incident detection, and HPV copy number (estimated using hybridization signal strength) of both oncogenic and nononcogenic HPV. All binary-regression analyses incorporated generalized estimating equations to address the repeated observations of the same women over time, and were further adjusted for parity, gestational age, smoking, antiretroviral use, number of lifetime sexual partners, and oral contraceptive use.

RESULTS: The prevalence and copy number of oncogenic and nononcogenic HPV did not significantly differ between pregnancy and either the prepregnancy or postpregnancy periods. Incident HPV detection was significantly lower for both oncogenic and nononcogenic HPV during pregnancy compared with the postpregnancy period (relative risk 0.534, 95% confidence interval 0.390–0.732, P<.001 and relative risk 0.577, 95% confidence interval 0.428–0.779, P<.001, respectively), but not compared with the prepregnancy period

CONCLUSION: Among HIV-infected women, the incident detection of HPV is lower during pregnancy compared with postpregnancy, while prevalence and copy number do no differ between pregnancy and either prepregnancy or postpregnancy.

LEVEL OF EVIDENCE: II-3