Genital HPV infection is highly prevalent and persistent in HIV-infected persons. A quadrivalent HPV vaccine (HPV-4v) is safe and effective among HIV-infected women and protects against high-risk (HR) HPV infections 16 and 18. Recently, a nonavalent HPV vaccine (HPV-9v) targeting HR-HPV types 16, 18, 31, 33, 45, 52, and 58, was approved. We examined the prevalence of these 7 HR-HPV types and associated abnormal cytology to assess the potential impact of the 9v vaccine.
From 2004 to 2006, the SUN study enrolled 167 women from 7 sites in 4 US cities in a prospective cohort. Providers collected cervical ThinPrep® cytobroom sweeps and Dacron® anal swabs for HPV detection and genotyping, and cytological examination, respectively, from participants every 12-months. We report results through 4 years of follow-up (F/U).
At baseline, in 43 women with data for all 5 visits, median age was 43 years, 51% were non-Hispanic black, 74% had HIV RNA <400 copies/mL, 88% were on cART, and 98% had CD4 cell counts >200 cells/mm3. HPV prevalence at the cervix and anus was 91% at baseline and 56% and 79%, respectively, at 48 months. The proportions of women with type 16 or 18 (HPV-4v) at the cervix and anus were, respectively, 28% and 30% at baseline, and 9% and 14% at 4 years. The proportions with HR-HPV types other than 16 and 18 (additional HR-HPV in HPV-9v) were, respectively, 26% and 35% at baseline, and 16% and 30% at 4 years. The proportions of women infected with any HR-HPV types in HPV-9v at the cervix and anus were, respectively, 53% and 65% at baseline, and 26% and 44% at 4 years. Over F/U, the rate of an abnormality was 51% in 37 women with cervical cytologies and 53% in 43 women with anal cytologies. In women with cervical abnormalities, 74% had HR-HPV types in HPV-9v detected at the same anatomic site; for those with anal abnormalities, 78% had HR-HPV types detected.
In HIV-infected women, prevalence of HPV infection decreased over 4years. While most HR-HPV types detected in abnormal cytologies are covered by HPV-9v, about a quarter of abnormal cervical and a fifth of abnormal anal cytologies had no HR-HPV types covered by the currently available HPV vaccines. Nonetheless, HPV-9v has potential to prevent a large proportion of cytologic abnormalities.
T. Bush, None
S. Cu-Uvin, None
E. Unger, None
K. Henry, GSK/ViiV: Investigator , Research grant
Gilead: Investigator , Research grant
Janssen: Investigator , Research grant
Merck: Investigator , Research grant
J. Hammer, None
G. Escota, None
T. Darragh, Hologic: Independent research , Research supplies for anal cytology for studies other than this project
J. Palefsky, Merck and Co.: Board Member and Grant Investigator , Research grant
Hologic: Grant Investigator , Grant recipient
J. T. Brooks, None
P. Patel, None
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