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  2nd International Workshop on HIV & Women
January 9-10, 2012
Bethesda, Maryland
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US Girls With HIV Have Doubled Rate of Anal HPV and Related Conditions
  2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland

Mark Mascolini

A 15-city comparison of adolescent girls with HIV and at risk for HIV found that the HIV group had a doubled incidence of anal human papillomavirus (HPV) infection, high-risk anal HPV, anogenital warts, and anal dysplasia (abnormal cell development) [1]. Smoking more than tripled the risk of high-risk anal HPV in the HIV-positive girls.

HPV infection, which can lead to cervical, vaginal, anal, and other cancers, is the most common sexually transmitted infection in the United States [2]. Because HIV-related immune deficits raise the risk of HPV infection and its clinical consequences, US researchers affiliated with the Reaching for Excellence in Adolescent Care and Health (REACH) Project compared anal HPV incidence (the new infection rate) and related developments in 12- to 18-year-old girls with behaviorally acquired HIV infection and a control group of adolescent girls at risk for HIV infection.

The study included 238 HIV-positive girls and the 139 HIV-negative girls, all of whom had at least one follow-up visit. All HIV-positive girls were behaviorally infected with HIV (only 2 through injecting drugs), and all HIV-negative girls were sexually active. The study excluded HIV-negative girls who got HIV infection during follow-up. There were 213 girls in an analysis of anal HPV and high-risk HPV, 350 in an anogenital wart analysis, and 222 in an anal dysplasia analysis.

Study participants averaged 16.7 years in age, and 74% were non-Hispanic black. Follow-up for the HPV analysis lasted for a median of 25.2 months in HIV-positive girls and 24.4 months in HIV-negative girls, while median follow-ups were 33.5 and 28.8 months for the wart analysis and 26.2 and 24.4 months for the dysplasia analysis.

Age at first sex was slightly lower in HIV-positive girls (13.6 versus 14.1 years), and a higher proportion of girls with HIV had 10 or more sex partners (32% versus 17%). Similar proportions in each group ever had receptive anal intercourse (20% with HIV and 28% without HIV), and similar proportions smoked (49% with HIV and 53% without HIV). HPV prevalence when the study began was higher in the HIV group than in the HIV-negative group (75% versus 56%).

Among the girls with HIV, 61% had ever taken an antiretroviral combination, and 44% were taking antiretrovirals at the time of the study. Viral load averaged 25,623 copies, and CD4 count averaged 548.

Compared with HIV-negative girls, the HIV-positive group had a higher incidence of anal HPV infection (30 versus 14 per 100 person-years, P = 0.002), high-risk anal HPV (12 versus 5.3 per 100 person-years, P = 0.04), anogenital warts (6.7 versus 1.6 per 100 person-years, P = 0.002), and anal dysplasia (12 versus 5.7 per 100 person-years).

Numerous factors raised the risk of HPV infection and HPV-related outcomes in HIV-positive and negative girls, at the following hazard ratios (HR) (and 95% confidence intervals):

High-risk HPV infection in HIV-positive girls:
-- Current smoking: HR 3.46 (1.21 to 9.89)
-- Late versus early CDC HIV disease stage: HR 2.80 (1.18 to, 6.67)

Anogenital warts in HIV-positive girls:
-- Cervical HPV infection: HR 4.28 (1.29 to 14.19)
-- Each 10-fold higher HIV load: HR 1.55 (1.12 to 2.17)

Anal dysplasia in HIV-positive girls:
-- Late versus early CDC HIV disease stage: HR 7.02 (2.18 to 22.59)
-- History of high-risk anal HPV infection: HR 3.72 (1.52 to 9.12)

Anal HPV infection in HIV-negative girls:
-- Cervical HPV infection: HR 2.45 (1.01 to 5.92)

"Because HIV-infected youth are at increased risk of HPV and related disease," the researchers proposed, "enhanced HPV prevention efforts, such as vaccination, are warranted for this group."

And because more advanced HIV infection and higher HIV loads boosted HPV-related risks, the investigators suggested that "minimizing HIV disease progression may reduce the risk of high-risk anal HPV and related outcomes in this vulnerable group."


1. Mullins TLK, Wilson CM, Rudy BJ, Sucharew H, Kahn JA. Incidence of anal HPV and HPV-related sequelae in HIV-infected and -uninfected adolescent women in the U.S. 2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland. Abstract O_9.

2. CDC. Genital HPV infection fact sheet. http://www.cdc.gov/std/hpv/stdfact-hpv.htm.