Persistência da infecção pelo papilomavírus humano em mulheres HIV-positivo

Abstract

Introduction: persistent infection by human papillomavirus (HPV) is essential in oncogenic progression to cervical intraepithelial neoplasia (CIN) high-grade and invasive cervical cancer. In immunosuppression from any cause, as in women infected with human immunodeficiency virus (HIV), the persistence of HPV is higher and is associated with the CIN. Objectives: To detect the persistence of high-risk HPV infection in HIV-positive women; evaluate the possible factors associated with this persistence; evaluate the prevalence of HPV infection in HIV-positive women and possible factors associated with the prevalence of high-risk HPV and to evaluate the prevalence and incidence of CIN in HIV-positive women. Methods: A cross-sectional analysis and cohort study in HIV-positive women treated at the Center for Training and Reference Infectious and Parasitic Diseases Orestes Diniz from 1997 to 2012. The polymerase chain reaction (PCR) for HPV detection was performed to the input of the patients in the study and follow-up. The probability of sociodemographic, and behavioral markers of HIV progression have effect on the prevalence and persistence of high-risk HPV was assessed by logistic regression. The significance level for the analyzes was 0.05. Results: In cross-sectional analysis, from 532 women overall prevalence was 68.2%, and HPV 6 was the most prevalent, followed by HPV 16. The prevalence of CIN in the first consultation was 17.4% (N = 93) and 12.2% (N = 65) of CIN 1, 4.3% (N = 23) CIN 2 and 0.9% ( N = 5) CIN 3. HPV prevalence differed in women with or without CIN on the baseline assessment. The prevalence was 63.7% in women without CIN and HPV type 6 was the most prevalent. In women with CIN prevalence was 88.1%, and HPV 16 was the most prevalent. The viral load 400 copies / mL was associated with the prevalence of HPV high risk with an odds ratio (OR) of 2.09 (confidence interval - CI 95% 1.41 to 3.11). The incidence of CIN was 3.5 per 100 person-years of follow up. Age <30 years (OR 0.29, 95% CI 0.15 to 0.57 for age 30 years, p <0.005), marital status unmarried, separated, divorced or widowed (OR of 2,46, 95% CI 1.30 to 4.63, p = 0.005), and CD4 count <200 cells/mm3 (OR of 2.78 and CI 1.16 to 6.67 and p value = 0.021) were associated with persistent high-risk HPV. Conclusions: HIV-positive women had higher HPV persistence, and type 16 was the most persistent, age <30 years, marital status unmarried, separated, divorced or widowed and low CD4 count (<200 cells/mm3) associated to the persistence of high-risk HPV, HIV-positive women had a high prevalence of HPV and type 16 was more prevalent, the high HIV viral load was associated with the prevalence of high-risk HPV, the incidence of CIN was low and high-grade CIN and invasive cancer were infrequent.