Cervical Abnormalities, Human Papillomavirus, and Human Immunodeficiency Virus Infections in Women in Malawi

In urban Malawi clinicians obtained cervicovaginal lavage samples and Pap smears from 138 of 284 women enrolled in a study at delivery during their 12-month postpartum visit so investigators could examine the association between human papilloma virus (HPV) and HIV infections. Cervical squamous intraepithelial lesions (SILs) were more common in women with HPV infection than those who did not have HPV infection (23% vs. 4%; odds ratio [OR] = 7.4; p < .001). The most common HPV types were types 16 and 18 the high risk types (50%). HIV seropositive women were more likely than HIV seronegative women to have SILs (15% vs. 7%; OR = 2.2; p = .05). More frequent HPV infections in HIV-infected women (48% vs. 23%; OR = 3.3; p < .001) probably accounted for this increased risk of SILs. The association between HPV and HIV infections was especially significant in HIV-infected women with less than 300 CD4 cells/cubic mm (60% vs. 23% for HIV negative women; OR = 4.98; p < .001). This association suggests that HIV-induced immunosuppression may increase womens susceptibility to HPV infection its reactivation or its duration. In women with high grade SILs the prevalence of Pap smear abnormalities was similar for both HIV seropositive (2%) and seronegative women (3%). 26% of women coinfected with HIV and HPV had SILs. HPV DNA in women who had been previously diagnosed with HPV infection was detected at the follow-up visit more often in HIV seropositive women than HIV seronegative women (75% vs. 23%; p = .02) suggesting that HIV infection adversely affects the bodys ability to clear HPV from the cervicovaginal area. These findings indicate a need for early detection of HPV and regular monitoring of HPV-related cervical lesions in HIV seropositive women.