Concomitant anal and cervical human papillomavirusV infections and intraepithelial neoplasia in HIV-infected and uninfected women

Objective:To assess factors associated with concomitant anal and cervical human papillomavirus (HPV) infections in HIV-infected and at-risk women.Design:A study nested within the Women's Interagency HIV Study (WIHS), a multicenter longitudinal study of HIV-1 infection in women conducted in six centers within the United States.Methods:Four hundred and seventy HIV-infected and 185 HIV-uninfected WIHS participants were interviewed and examined with anal and cervical cytology testing. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV testing. Women with abnormal cytologic results had colposcopy or anoscopy-guided biopsy of visible lesions. Logistic regression analyses were performed and odds ratios (ORs) measured the association for concomitant anal and cervical HPV infection.Results:One hundred and sixty-three (42%) HIV-infected women had detectable anal and cervical HPV infection compared with 12 (8%) of the HIV-uninfected women (P<0.001). HIV-infected women were more likely to have the same human papillomavirus (HPV) genotype in the anus and cervix than HIV-uninfected women (18 vs. 3%, P<0.001). This was true for both oncogenic (9 vs. 2%, P=0.003) and nononcogenic (12 vs. 1%, P<0.001) HPV types. In multivariable analysis, the strongest factor associated with both oncogenic and nononcogenic concomitant HPV infection was being HIV-infected (OR=4.6 and OR=16.9, respectively). In multivariable analysis of HIV-infected women, CD4(+) cell count of less than 200 was the strongest factor associated with concomitant oncogenic (OR=4.2) and nononcogenic (OR=16.5) HPV infection.Conclusion:HIV-infected women, particularly those women with low CD4(+) cell counts, may be good candidates for HPV screening and monitoring for both cervical and anal disease.