Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy

Abstract Background Natural history of HPV infection is altered in HIV positive women, with increased risk of cervical dysplasia. Limited data are available about the influence of HPV genotypes and HPV multiple infections on cervical disease in HIV positive women. Objectives We determined HPV genotype prevalence in cervical samples from 553 HIV-infected women attending the gynaecological service at “L. Spallanzani” Hospital. Association of HPV multiple infections with cervical abnormalities was investigated. Study design MY09/MY11 consensus primers were used to detect HPV-DNA; HPV typing was performed by RFLP. A commercial array based kit was used to define unresolved RFLP patterns. Results HPV was detected in 244/553 (44.1%) patients, correlating with low CD4 counts ( p p  = 0.001). Multiple HPV types were observed in 44.4% of cases, more frequently involving HR than LR HPV (OR = 12.8, p 3 ). Dyskaryosis was associated with decreased CD4 counts (≥500 vs 200–499 vs 3 , χ 2 for trend, p  = 0.001) and with HPV types multiplicity (1 vs 2–3 vs ≥4, χ 2 for trend, p n  = 2; HPV81, n  = 1). Conclusions Multiple HPV infections, often involving HR types, are frequent in HIV-infected women. Association between multiple HPV infection, low CD4 count and cytological abnormalities supports the interplay of virological and immunological factors in cervical cancer pathogenesis. Assessment of multiple HPV infections might gain importance in cervical cancer screening, particularly in patients with predisposing factors like immuno-suppression.