Objective Women living with HIV have an increased risk of human papillomavirus (HPV) infection and cervical cancer. Little is known about genotype-specific HPV prevalence, the impact of antiretroviral therapy, immunological status, and additional risk factors in women living with HIV in Germany. The goal of this study was to characterize the risk profile for cervical dysplasia in these women.
Methods Patients with HIV infection presenting at Charité-Universitätsmedizin Berlin from October 2017 to September 2020 were included and underwent gynecological examination, colposcopy, cervical cytology and HPV genotype testing. HPV genotypes were stratified by carcinogenicity. Atypical squamous cells of undetermined significance or higher were considered abnormal cytology. Data were analyzed by SPSS software (version 26, 2019). A two-tailed p-value ≤0.05 was considered statistically significant.
Results A total of 84 women were evaluated. The majority (95.2%) received antiretroviral therapy. Median CD4 cell count was 564 cells/µl (range 20–1969). 95.2% were previously screened for cervical cancer. High-risk HPV prevalence was 44%. High-high-risk HPV subtypes (16, 18, 31, 33, 45, 52, 58) were significantly associated with abnormal cytology (p<0.001). HPV16 was the most common genotype (23%), was significantly associated with abnormal cytology (p=0.002) and was the main risk factor for abnormal cytology (OR 8.55, 95% CI 2.15 to 34.13, p=0.002), followed by age <35 years (OR 4.96, 95% CI 1.23 to 19.61, p=0.033) and cigarette smoking (OR 3.944, 95% CI 0.98 to 15.88, p=0.053).
Conclusions Antiretroviral therapy and adherence to cervical cancer screening was high. High-high-risk HPV, especially HPV16, coincided with high incidence of cytological abnormalities. Women living with HIV in Germany have adequate immune status and are often pre-screened for cervical cancer, and therefore have a different risk profile for cervical dysplasia than in low-income or medium-income countries. Adapted screening programs should be defined.
- cervical cancer
- cervix uteri
- uterine cervical neoplasms
- genitalia, female
Data availability statement
Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.
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Contributors The authors contributed to the production of this paper in the following ways: AW: conception of the study, literature review, data collection, data analysis and interpretation, statistical analysis, writing of manuscript, manuscript review. AS: data collection, data analysis, manuscript review. JS: data interpretation, manuscript review. RR: statistical analysis, manuscript review. WH: manuscript review. KvW: data collection, manuscript review. J-PS: data collection, manuscript review. RC: data interpretation, writing of manuscript, manuscript review. AMK: conception of the study, data collection, data analysis and interpretation, manuscript review. IR: conception of the study, data collection, data analysis and interpretation, manuscript review, guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JS: President Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO e.V.), Member Prevention Committee European Society of Gynaecological Oncology.
Provenance and peer review Not commissioned; externally peer reviewed.
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