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Obstetrics & Gynecology 2000;96:403-409
© 2000 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Increased Risk of Cervical Disease Among Human Immunodeficiency Virus–Infected Women With Severe Immunosuppression and High Human Papillomavirus Load

ISABELLE HEARD, MD, JEAN-MICHEL TASSIE, MD, VALERIE SCHMITZ, MS, LAURENT MANDELBROT, MD, MICHEL D. KAZATCHKINE, MD, PhD and GÉRARD ORTH, PhD

From the Institut National de la Santé et de la Recherche Médicale (INSERM) U430 and Unité d’Immunologie Clinique, Hôpital Broussais; Service d’Obstétrique et de Gynécologie, Hópital Cochin; INSERM SC4, Faculté de Médecine Saint-Antoine; Unité Mixte Institut Pasteur–INSERM U190, Institut Pasteur, Paris, France.

Address reprint requests to: Isabelle Heard, MD Unité INSERM 430 Immunopathologie Humaine Höpital Broussais, 96 rue Didot 75674 Paris Cedex 14 France E-mail: isabelle.heard{at}brs.ap-hop-paris.fr

Objective: To investigate human papillomavirus (HPV) genotypes, HPV DNA load, and behavioral and sociodemographic factors in a series of human immunodeficiency virus (HIV)-seropositive women, and to correlate HPV infection with cervical disease according to immune status.

Methods: Three hundred seven HIV-seropositive women were tested for the presence of HPV DNA by polymerase chain reaction (PCR) and Southern blot hybridization. Cervical disease was assessed using Papanicolaou smears, colposcopy, and biopsies when necessary. Various risk factors for cervical intraepithelial neoplasia (CIN) were tested using multiple logistic regression analysis.

Results: Cervical disease was diagnosed in 83 (27.0%) of 307 women and HPV infection in 162 (52.8%). High HPV load (as detectable by Southern blot hybridization) was found in 90 (55.6%) of the 162 infected women. Potentially oncogenic or related genotypes were detected in 74 (82.2%) of these 90 cases. High-load HPV infection was twice as frequent in severely immunosuppressed women (CD4 cell count less than 200/µL) as in women with higher CD4 cell counts (P = .002). High-load HPV infection was associated with a high risk of cervical disease (adjusted odds ratio [OR] 16.8; 95% confidence interval [CI] 7.0, 40.3). The risk among severely immunosuppressed women was ten times greater than that among women with CD4 cell counts of at least 200/µL. Low-load HPV infection (detected by PCR only) was a risk factor for CIN in severely immunosuppressed women only (adjusted OR 7.4; 95% CI 1.3, 43.0).

Conclusion: Immunosuppression favors cervical high-load HPV infection with oncogenic genotypes and its clinical expression in HIV-seropositive women.




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