More human papilloma virus shedding with HIV.(Gynecology)

BETHESDA, MD. -- HIV-infected women have higher rates of human papilloma virus shedding and higher rates of high grade cervical intraepithelial neoplasia, and are diagnosed more frequently with vulvar intraepithelial neoplasia (VIN) than are women who are not infected, Thomas C. Wright Jr., M.D., said at a conference on vulvovaginal diseases.

Women infected with HIV have an increased rate of human papilloma virus (HPV) shedding that is generally estimated at about four times that of HIV-negative women, said Dr. Wright, director of obstetrics, gynecology, and pathology at Columbia University College of Physicians and Surgeons, New York.

Among HPV-infected women, those who are also infected with HIV have more HPV types than do women without HIV. In one study conducted in New York City, 31% of HIV-positive women had more than one HPV type, vs. 9% of HIV-negative women. A total of 16% and 14% had HPV 16 and HPV 18, respectively, in the HIV-positive group vs. 6% and 3%, respectively, in HIV-negative women.

Studies conducted in the 1990s determined that the distribution of HPV types in women without cervical intraepithelial neoplasia (CIN) tend to be the same in those who are HIV positive and those who are HIV negative. But women with biopsy-confirmed CIN 2,3 who are HIV positive "tend to be more heterogenous for high risk [HPV] types" he said.

Types 16 and 18, which tend to be the most common high-risk HPV types in the general population and appear to be more aggressive than other high-risk HPV types, are found in considerable numbers of CIN 2,3 cases in both HIV-infected and uninfected women. However, in HIV-infected women, the other HPV types that can cause cancer "may become a little more pathogenic" as the immune system deteriorates, Dr. Wright noted.

Viral load and CD4 counts have both been found to be markers for patients who shed HPV: The Women's Interagency HIV Study (WIHS) published in 1999 found that HPV was detected more frequently in women with low (under 200) CD4 counts, regardless of their HIV viral load. Similarly, women with a high HIV viral load, even with a higher CD4 count, will have high rates of HPV shedding, Dr. Wright said at the conference, sponsored by the American Society for Colposcopy and Cervical Pathology.

For more than a decade, it has been clear that the prevalence of CIN among HIV-positive women is high, estimated at two to four times higher than among noninfected women. Dr. Wright referred to four large prospective follow-up studies, including one that he and his associates conducted in New York City, which found that the rates of abnormal cytology in HIV-positive women ranged from 30% to 40%, vs. 8% to 20% among HIV-negative women.