HPV Cervical Neoplasia in a Long-Term HIV+ Cohort

Investigator: Joel Palefsky, MD
Sponsor: Albert Einstein College of Medicine

Location(s): United States


Human papillomavirus (HPV) is the central etiologic agent in the development of most cervical neoplasms, including invasive cervical cancer. HIV-positive women are at substantially elevated risk for HPV infection as well as cervical disease, and this risk increases with diminished CD4+ T-cell and/or higher HIV RNA levels. Surprisingly few studies, however, have assessed the natural history of HPV infection in HIV-positive women. Gaps in our knowledge include the persistence of HPV DNA in HIV-positive women and its relation with risk of cervical neoplasms. Reactivation of latent HPV infections has been suggested to be important in immune compromised individuals, but clear evidence that this occurs is lacking. The effects of highly active anti- retroviral therapy (HAART) on HPV natural history are unknown. The purpose of this application is to study the long term effects of HIV on the natural history of HPV infection and the development of cervical neoplasms, using specimens obtained from the Women's Interagency HIV Study (WIHS). The WIHS cohort is a large, geographically and ethnically diverse population of HIV- positive (n=2056), and risk-matched HIV-negative women (n=569). Since enrollment (October, 1994 - November 1995) WIHS subjects have been followed at 6 month intervals. We have analyzed HPV and cytologic results at enrollment, but HPV DNA testing for most planned visits (years 2- 7 of follow-up) has not been arranged. Under this application we will test all untested cervical specimens for HPV DNA, and specimens positive for HPV 16, 18 and/or 31 will be further tested to identify the type-specific variant. Serum antibodies to papillomavirus antigens, including a panel of virus-like particles, will be measured. Our specific aims include:

 (1) To study the relation of HIV serostatus, CD4+ T-cell, HIV RNA levels, and use of HAART with risk of 3 outcomes, namely, incident type-specific HPV DNA detection, persistence of HPV DNA, and incident cervical neoplasms; 
(2) To determine whether HPV can become latent and then be reactivated; and 
(3) To study humoral immune responses to HPV and their relation with HPV natural history in HIV-positive and -negative women.