1023
Cervical Human Papillomavirus Infection in HIV-1-infected Pregnant Women in Zimbabwe
David Hill*1, D Katzenstein1, A Shetty2, C Ley3, J Palefsky4, and Y Maldonado1
1Stanford Univ Sch of Med, Palo Alto, CA, US; 2Wake Forest Univ Baptist Med Ctr, Winston-Salem, NC, US; 3Caradon Consulting, San Carlos, CA, US; and 4Univ of California, San Francisco, US
Background: Protective
human papilloma virus (HPV) immunization and ART are interventions to reduce cervical
cancer and the sexual and vertical transmission of HIV. However, the 2 current
HPV vaccines are only known to be effective against specific types (16 and 18) of
HPV. In Zimbabwe, we surveyed HPV genotypes among HIV+ pregnant women
infected with subtype C HIV-1 and assessed cervical HPV infection and HIV-1 virus
shedding.
Methods: HIV-1
(subtype C) -positive pregnant women in Zimbabwe were evaluated for HIV and HPV
infection by assays of cervical swab samples. For HPV, real-time polymerase
chain reaction (RT-PCR) was performed followed by a generic (“consensus”) HPV
probe using DNA hybridization, and positive samples were re-probed for 29
individual HPV types and a probe mixture of 10 types. Cervical HIV RNA was
measured by a modified Amplicor RT-PCR of viral particles concentrated from the
supernatant and expressed as log copies/ml with a lower limit of detection of
2.29.
Results: A total
of 119 subjects were enrolled; 5 were excluded from HPV analyses because of
insufficient DNA. With the generic probe, 82% (94 of 114) of samples were HPV+.
Re-probing identified 27 unique HPV types in 72 women; 58% (66 of 114) had high
cancer risk genotypes; HPV 58 in 19 women, followed by HPV 66, found in 14
women. HIV cervical virus was detected in 46 of 52 (88%) of cervical samples
tested, with a median cervical virus load of 3.54 log copies/mL. There was no
correlation between HIV-1 shedding and the presence of HPV, or specific HPV
types in cervical samples.
Conclusions: A
high proportion of HIV+ pregnant women in Zimbabwe shed HIV-1 RNA and
carried high risk cervical HPV types associated with increased cervical cancer
risk. However, only 16 of 94 (17%) were infected with HPV-16 or -18, types
against which current vaccines are known to be protective. These data suggest
that current HPV vaccines may not prevent HPV infections or provide protection
against the high risk HPV types prevalent among HIV-infected women in Zimbabwe.
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