Increased risk of cervical disease among human immunodeficiency virus-infected women with severe immunosuppression and high human papillomavirus load

被引:110
作者
Heard, I
Tassie, JM
Schmitz, V
Mandelbrot, L
Kazatchkine, MD
Orth, G
机构
[1] Hop Broussais, INSERM, U430, F-75674 Paris 14, France
[2] Hop Broussais, Unite Immunol Clin, F-75674 Paris 14, France
[3] Hop Cochin, Serv Obstet & Gynecol, F-75674 Paris, France
[4] Univ Paris 06, INSERM, SC4, Paris, France
[5] Inst Pasteur, INSERM, U190, Unite Mixte Inst Pasteur, Paris, France
关键词
D O I
10.1016/S0029-7844(00)00948-0
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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/mu L) 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/mu L. 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. (Obstet Gynecol 2000;96:403-9. (C) 2000 by The American College of Obstetricians and Gynecologists.).
引用
收藏
页码:403 / 409
页数:7
相关论文
共 45 条
  • [1] HUMAN PAPILLOMAVIRUS INFECTION AND CERVICAL INTRAEPITHELIAL NEOPLASIA IN WOMEN WITH RENAL-ALLOGRAFTS
    ALLOUB, MI
    BARR, BBB
    MCLAREN, KM
    SMITH, IW
    BUNNEY, MH
    SMART, GE
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 1989, 298 (6667): : 153 - 156
  • [2] Systemic immunosuppression by HIV infection influences HPV transcription and thus local immune responses in condyloma acuminatum
    Arany, I
    Tyring, SK
    [J]. INTERNATIONAL JOURNAL OF STD & AIDS, 1998, 9 (05) : 268 - 271
  • [3] Lack of evidence for a role of human papillomaviruses in transitional cell carcinoma of the bladder
    Lerner, SP
    [J]. JOURNAL OF UROLOGY, 1998, 159 (01) : 98 - 99
  • [4] GENITAL HUMAN PAPILLOMAVIRUS INFECTION IN FEMALE UNIVERSITY-STUDENTS AS DETERMINED BY A PCR-BASED METHOD
    BAUER, HM
    TING, Y
    GREER, CE
    CHAMBERS, JC
    TASHIRO, CJ
    CHIMERA, J
    REINGOLD, A
    MANOS, MM
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (04): : 472 - 477
  • [5] PREVALENCE OF HUMAN PAPILLOMAVIRUS IN CERVICAL-CANCER - A WORLDWIDE PERSPECTIVE
    BOSCH, FX
    MANOS, MM
    MUNOZ, N
    SHERMAN, M
    JANSEN, AM
    PETO, J
    SCHIFFMAN, MH
    MORENO, V
    KURMAN, R
    SHAH, KV
    ALIHONOU, E
    BAYO, S
    MOKHTAR, HC
    CHICAREON, S
    DAUDT, A
    DELOSRIOS, E
    GHADIRIAN, P
    KITINYA, JN
    KOULIBALY, M
    NGELANGEL, C
    TINTORE, LMP
    RIOSDALENZ, JL
    SARJADI
    SCHNEIDER, A
    TAFUR, L
    TEYSSIE, AR
    ROLON, PA
    TORROELLA, M
    TAPIA, AV
    WABINGA, HR
    ZATONSKI, W
    SYLLA, B
    VIZCAINO, P
    MAGNIN, D
    KALDOR, J
    GREER, C
    WHEELER, C
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1995, 87 (11): : 796 - 802
  • [6] BRAUN L, 1994, AM J PATHOL, V144, P209
  • [7] COMPARISON OF CYTOBRUSH AND CERVICOVAGINAL LAVAGE SAMPLING METHODS FOR THE DETECTION OF GENITAL HUMAN PAPILLOMAVIRUS
    GOLDBERG, GL
    VERMUND, SH
    SCHIFFMAN, MH
    RITTER, DB
    SPITZER, C
    BURK, RD
    [J]. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1989, 161 (06) : 1669 - 1672
  • [8] Lack of behavioural risk factors for squamous intraepithelial lesions (SIL) in HIV-infected women
    Heard, I
    Jeannel, D
    Bergeron, C
    Saada, M
    Henrion, R
    Kazatchkine, MD
    [J]. INTERNATIONAL JOURNAL OF STD & AIDS, 1997, 8 (06) : 388 - 392
  • [9] Early regression of cervical lesions in HIV-seropositive women receiving highly active antiretroviral therapy
    Heard, I
    Schmitz, V
    Costagliola, D
    Orth, G
    Kazatchkine, MD
    [J]. AIDS, 1998, 12 (12) : 1459 - 1464
  • [10] PERSISTENT GENITAL HUMAN PAPILLOMAVIRUS INFECTION AS A RISK FACTOR FOR PERSISTENT CERVICAL DYSPLASIA
    HO, GYF
    BURK, RD
    KLEIN, S
    KADISH, AS
    CHANG, CJ
    PALAN, P
    BASU, J
    TACHEZY, R
    LEWIS, R
    ROMNEY, S
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1995, 87 (18): : 1365 - 1371