HPV types in cervical precancer by HIV status and birth region: a population-based register study.

BACKGROUND Data is lacking regarding which HPV types cause high-grade cervical neoplasia (CIN2+) in people with HIV in Europe. We assessed which HPV types are associated with CIN2+ in women living in Sweden by HIV status. METHODS The Swedish National HIV Registry, the Swedish Population Registry, and the Swedish National Cervical Screening Registry were linked. CIN2+ tissue blocks of 130 women living with HIV (WLWH) and 234 HIV-negative women, matched for country of birth (1:2), were retrieved from bio-banks and HPV genotyped. Adjusted odds ratios (adjOR), stratified by country of birth, were calculated using Conditional logistic regression. Matching was broken for cross-group comparisons. RESULTS WLWH with CIN2 were less likely to have HPV16 (14% vs. 40%, adjOR 0.1, 95% CI 0.04-0.56) than HIV-negative women, but among women with CIN3 there was no difference in HPV16 prevalence by HIV status (adjOR 0.9, 95% CI 0.51-1.70). WLWH were six times more likely to have HPV35 in CIN3 than HIV-negative women (adjOR 6.2, 95% CI 1.3-30.4). WLWH from sub-Saharan Africa (SSA) had less 9-valent vaccine-types, compared to both HIV-negative women born in Sweden (adjOR 0.1, 95% CI 0.02-0.44) and WLWH born in Sweden (adjOR 0.1, 95% CI 0.01-0.73), mostly because of decreased HPV16 and increased HPV35. CONCLUSIONS WLWH from sub-Saharan Africa were less likely covered by the 9-valent vaccine, mostly due to less HPV16 and more HPV35. IMPACT This could have implications for HPV-vaccines, currently not including HPV35, and for HPV-screening algorithms in women with origin from SSA.