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Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 2001;9(2):89–93. doi: 10.1155/S1064744901000163

Human Papillomavirus Typing in HIV-Positive Women

Meera Hameed 1, Helen Fernandes 1, Joan Skurnick 2, Dorothy Moore 1, Patricia Kloser 3, Debra Heller 1,
PMCID: PMC1784640  PMID: 11495559

Abstract

Objective: Human papillomavirus (HPV) is the major cause of cervical carcinoma and cervical intraepithelial neoplasia worldwide. Certain HPV types have a strong association with and probably a causative role in the pathogenesis of premalignant cervical lesions. Epidemiologic studies in women infected by the human immunodeficiency virus (HIV) have shown an increased incidence of squamous intraepithelial lesions (SILs), whichwere predominantly high-grade. Six to 30 per cent of women diagnosed with atypical squamous cells of undetermined significance (ASCUS) on a Papanicolaou (Pap) smear harbor SIL in normal screening populations. This study was undertaken to determine the presence of low- and high-risk HPV types in women infected by HIV and to correlate the results to those of the Pap smear.

Study design: HPV DNA typing (low- and high-risk) by Digene™ (Digene Corporation, Gathesburg, MD) hybrid capture methodology was performed on cervical swabs from 209 HIV-positive women. The results of HPV typing were correlated with those of the Pap smear in a retrospective analysis.

Results: One hundred and one women (48%) tested positive for HPV subtypes by DNA typing by the hybrid capture method. Of these, 64 patients (63%) had Pap smears whichwere read as being normal, having benign cellular changes, or having ASCUS (favor reactive process). Of these, 19 patients tested positive for both high-risk and low-risk subtypes, 32 patients tested positive only for high-risk subtypes, and 13 patients tested positive only for low-risk subtypes.

Conclusion: HPV subtyping identifies a significant group of HIV-positive women who are at risk for developing cervical intraepithelial neoplasia, although they may not show significant abnormalities on their Pap smears.

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Selected References

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  1. Alani R. M., Münger K. Human papillomaviruses and associated malignancies. J Clin Oncol. 1998 Jan;16(1):330–337. doi: 10.1200/JCO.1998.16.1.330. [DOI] [PubMed] [Google Scholar]
  2. Cox J. T., Lorincz A. T., Schiffman M. H., Sherman M. E., Cullen A., Kurman R. J. Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 1995 Mar;172(3):946–954. doi: 10.1016/0002-9378(95)90026-8. [DOI] [PubMed] [Google Scholar]
  3. Crum C. P., Genest D. R., Krane J. F., Hogan C., Sun D., Bellerose B., Kostopoulou E., Lee K. R. Subclassifying atypical squamous cells in Thin-Prep cervical cytology correlates with detection of high-risk human papillomavirus DNA. Am J Clin Pathol. 1999 Sep;112(3):384–390. doi: 10.1093/ajcp/112.3.384. [DOI] [PubMed] [Google Scholar]
  4. Cuzick J., Terry G., Ho L., Hollingworth T., Anderson M. Human papillomavirus type 16 in cervical smears as predictor of high-grade cervical intraepithelial neoplasia [corrected]. Lancet. 1992 Apr 18;339(8799):959–960. doi: 10.1016/0140-6736(92)91532-d. [DOI] [PubMed] [Google Scholar]
  5. Davey D. D., Naryshkin S., Nielsen M. L., Kline T. S. Atypical squamous cells of undetermined significance: interlaboratory comparison and quality assurance monitors. Diagn Cytopathol. 1994 Dec;11(4):390–396. doi: 10.1002/dc.2840110416. [DOI] [PubMed] [Google Scholar]
  6. Farthing A., Masterson P., Mason W. P., Vousden K. H. Human papillomavirus detection by hybrid capture and its possible clinical use. J Clin Pathol. 1994 Jul;47(7):649–652. doi: 10.1136/jcp.47.7.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fujinaga Y., Shimada M., Okazawa K., Fukushima M., Kato I., Fujinaga K. Simultaneous detection and typing of genital human papillomavirus DNA using the polymerase chain reaction. J Gen Virol. 1991 May;72(Pt 5):1039–1044. doi: 10.1099/0022-1317-72-5-1039. [DOI] [PubMed] [Google Scholar]
  8. Hildesheim A., Schiffman M. H., Gravitt P. E., Glass A. G., Greer C. E., Zhang T., Scott D. R., Rush B. B., Lawler P., Sherman M. E. Persistence of type-specific human papillomavirus infection among cytologically normal women. J Infect Dis. 1994 Feb;169(2):235–240. doi: 10.1093/infdis/169.2.235. [DOI] [PubMed] [Google Scholar]
  9. Ho G. Y., Burk R. D., Fleming I., Klein R. S. Risk of genital human papillomavirus infection in women with human immunodeficiency virus-induced immunosuppression. Int J Cancer. 1994 Mar 15;56(6):788–792. doi: 10.1002/ijc.2910560605. [DOI] [PubMed] [Google Scholar]
  10. Kaufman R. H., Adam E., Vonka V. Human papillomavirus infection and cervical carcinoma. Clin Obstet Gynecol. 2000 Jun;43(2):363–380. doi: 10.1097/00003081-200006000-00016. [DOI] [PubMed] [Google Scholar]
  11. Kiyabu M. T., Shibata D., Arnheim N., Martin W. J., Fitzgibbons P. L. Detection of human papillomavirus in formalin-fixed, invasive squamous carcinomas using the polymerase chain reaction. Am J Surg Pathol. 1989 Mar;13(3):221–224. doi: 10.1097/00000478-198903000-00007. [DOI] [PubMed] [Google Scholar]
  12. Koutsky L. A., Holmes K. K., Critchlow C. W., Stevens C. E., Paavonen J., Beckmann A. M., DeRouen T. A., Galloway D. A., Vernon D., Kiviat N. B. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. 1992 Oct 29;327(18):1272–1278. doi: 10.1056/NEJM199210293271804. [DOI] [PubMed] [Google Scholar]
  13. Laga M., Icenogle J. P., Marsella R., Manoka A. T., Nzila N., Ryder R. W., Vermund S. H., Heyward W. L., Nelson A., Reeves W. C. Genital papillomavirus infection and cervical dysplasia--opportunistic complications of HIV infection. Int J Cancer. 1992 Jan 2;50(1):45–48. doi: 10.1002/ijc.2910500110. [DOI] [PubMed] [Google Scholar]
  14. Lorincz A. T., Temple G. F., Kurman R. J., Jenson A. B., Lancaster W. D. Oncogenic association of specific human papillomavirus types with cervical neoplasia. J Natl Cancer Inst. 1987 Oct;79(4):671–677. [PubMed] [Google Scholar]
  15. Mandelblatt J. S., Fahs M., Garibaldi K., Senie R. T., Peterson H. B. Association between HIV infection and cervical neoplasia: implications for clinical care of women at risk for both conditions. AIDS. 1992 Feb;6(2):173–178. [PubMed] [Google Scholar]
  16. Manos M. M., Kinney W. K., Hurley L. B., Sherman M. E., Shieh-Ngai J., Kurman R. J., Ransley J. E., Fetterman B. J., Hartinger J. S., McIntosh K. M. Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA. 1999 May 5;281(17):1605–1610. doi: 10.1001/jama.281.17.1605. [DOI] [PubMed] [Google Scholar]
  17. Piper M. A., Severin S. T., Wiktor S. Z., Unger E. R., Ghys P. D., Miller D. L., Horowitz I. R., Greenberg A. E., Reeves W. C., Vernon S. D. Association of human papillomavirus with HIV and CD4 cell count in women with high or low numbers of sex partners. Sex Transm Infect. 1999 Aug;75(4):253–257. doi: 10.1136/sti.75.4.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Reid R., Greenberg M. D., Lorincz A., Jenson A. B., Laverty C. R., Husain M., Daoud Y., Zado B., White T., Cantor D. Should cervical cytologic testing be augmented by cervicography or human papillomavirus deoxyribonucleic acid detection? Am J Obstet Gynecol. 1991 Jun;164(6 Pt 1):1461–1471. doi: 10.1016/0002-9378(91)91425-v. [DOI] [PubMed] [Google Scholar]
  19. Rezza G., Giuliani M., Branca M., Benedetto A., Migliore G., Garbuglia A. R., D'Ubaldo C., Pezzotti P., Cappiello G., Pomponi Formiconi D. Determinants of squamous intraepithelial lesions (SIL) on Pap smear: the role of HPV infection and of HIV-1-induced immunosuppression. DIANAIDS Collaborative Study Group. Eur J Epidemiol. 1997 Dec;13(8):937–943. doi: 10.1023/a:1007466908865. [DOI] [PubMed] [Google Scholar]
  20. Schiffman M. H. Recent progress in defining the epidemiology of human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst. 1992 Mar 18;84(6):394–398. doi: 10.1093/jnci/84.6.394. [DOI] [PubMed] [Google Scholar]
  21. Schrager L. K., Friedland G. H., Maude D., Schreiber K., Adachi A., Pizzuti D. J., Koss L. G., Klein R. S. Cervical and vaginal squamous cell abnormalities in women infected with human immunodeficiency virus. J Acquir Immune Defic Syndr. 1989;2(6):570–575. [PubMed] [Google Scholar]
  22. Syrjänen S., Saastamoinen J., Chang F. J., Ji H. X., Syrjänen K. Colposcopy, punch biopsy, in situ DNA hybridization, and the polymerase chain reaction in searching for genital human papillomavirus (HPV) infections in women with normal PAP smears. J Med Virol. 1990 Aug;31(4):259–266. doi: 10.1002/jmv.1890310404. [DOI] [PubMed] [Google Scholar]
  23. Tweddel G., Heller P., Cunnane M., Multhaupt H., Roth K. The correlation between HIV seropositivity, cervical dysplasia, and HPV subtypes 6/11, 16/18, 31/33/35. Gynecol Oncol. 1994 Feb;52(2):161–164. doi: 10.1006/gyno.1994.1024. [DOI] [PubMed] [Google Scholar]
  24. Uberti-Foppa C., Origoni M., Maillard M., Ferrari D., Ciuffreda D., Mastrorilli E., Lazzarin A., Lillo F. Evaluation of the detection of human papillomavirus genotypes in cervical specimens by hybrid capture as screening for precancerous lesions in HIV-positive women. J Med Virol. 1998 Oct;56(2):133–137. doi: 10.1002/(sici)1096-9071(199810)56:2<133::aid-jmv6>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  25. Vernon S. D., Unger E. R., Piper M. A., Severin S. T., Wiktor S. Z., Ghys P. D., Miller D. L., Horowitz I. R., Greenberg A. E., Reeves W. C. HIV and human papillomavirus as independent risk factors for cervical neoplasia in women with high or low numbers of sex partners. Sex Transm Infect. 1999 Aug;75(4):258–260. doi: 10.1136/sti.75.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wright T. C., Jr, Sun X. W. Anogenital papillomavirus infection and neoplasia in immunodeficient women. Obstet Gynecol Clin North Am. 1996 Dec;23(4):861–893. doi: 10.1016/s0889-8545(05)70280-1. [DOI] [PubMed] [Google Scholar]
  27. Wright T. C., Sun X. W., Koulos J. Comparison of management algorithms for the evaluation of women with low-grade cytologic abnormalities. Obstet Gynecol. 1995 Feb;85(2):202–210. doi: 10.1016/0029-7844(94)00373-L. [DOI] [PubMed] [Google Scholar]
  28. de Villiers E. M. Heterogeneity of the human papillomavirus group. J Virol. 1989 Nov;63(11):4898–4903. doi: 10.1128/jvi.63.11.4898-4903.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]

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