Background:  The prevalence of HPV infections in HIV-positive women is higher and bears a worse prognosis than in HIV-negative women. Because prevalence and natural history of HPV infection are tightly interconnected with host factors, we analysed mucosal immune profiles of HIV/HPV co-infected patients and of singularly HIV- or HPV-infected women

Methods:  Cross-sectional study of 27 HIV-seropositive and 21 HIV-seronegative women with or without cervical HPV infection with HPV strains at high risk of malignant transformation. Pap smear, colposcopy, vaginal microbiological assessment, virologic test Hybrid Capture II (Digene) for HPV-DNA (high and low risk) were performed at recruitment. Immunohistochemistry was performed in cervical biopsies to quantify cytokine production (IFN-g, TNF-a, IL-5, IL-10) and expression of surface markers (CD4, CD8, CD1a). Leukemia inhibitory factor production, a soluble endogenous HIV suppressive factor, was also evaluated.

Results:  CD4⁺, CD8⁺, and CD1a cells were augmented and the CD4/CD8 ratio was reduced (p = 0.02) in HIV/HPV-co-infected patients. HIV/HPV-co-infection was also associated with decreased IFN-g production (p = 0.01) and augmented generation of TNF-a, IL-10, IL-5, and leukemia inhibitory factor compared with either HIV- or HPV-singularly infected women. Cervical bioptic samples obtained either from the lesional site or from the controlateral healthy portion showed that the CD4/CD8 ratio was significantly decreased (p =  0.03) and TNF-a and IL-10 production was markedly increased in the lesional site.

Conclusions:  HPV infection in HIV/HPV co-infected women is associated with altered mucosal immunity and, in particular, with the activation of pro-inflammatory cytokines and an impairment of cell mediated immunity. HIV and HPV co-infection results in a profound, possibly synergistic, alteration of local immunity.

Keywords: HIV; HPV; immunology