Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance among Women in Senegal, West Africa

Abstract

Background. Persistent infection with high-risk human papillomavirus (HPV) is associated with development of invasive cervical cancer. Methods. Longitudinal data was collected from 174 Senegalese women. We employed marginal Cox proportional hazards models to examine the effect of human immunodeficiency virus (HIV) status (HIV positive vs HIV negative) and HIV type (HIV-1 vs HIV-2 vs dual HIV-1/HIV-2) on clearance of type-specific HPV infection. Analyses were stratified by incident versus prevalent HPV infection. Results. Incident HPV infections in HIV-positive women were less likely to clear than those in HIV-negative women (adjusted hazard ratio [HR] = 0.60; 95% confidence interval [CI], .38–.94). Among HIV-positive women, HIV-2–infected women and HIV-1/ 2 dually infected women were more likely to clear HPV incident infections than HIV-1–infected women (HR = 1.66; 95% CI, .95–2.92 and HR = 2.17; 95% CI, 1.12–4.22, respectively). Incident HPV infections in HIV-positive women with CD4 cell count ≤500 cells/μL were less likely to clear than those in HIV-positive women with CD4 cell count >500 cells/μL (HR = 0.65; 95% CI, .42–1.01). No significant associations were observed for prevalent HPV infections. Conclusions. HIV infection reduced the likelihood of clearance of incident HPV infection. Furthermore, among HIV-positive women, low CD4 cell count and dual HIV infection were each associated with reduced likelihood of clearance.