Unique human papillomavirus-type distribution in South African women with invasive cervical cancer and the effect of human immunodeficiency virus infection

Abstract

OBJECTIVES : Cervical cancer is the most common cause of cancer-related deaths among South African women. Viral types associated with cervical cancer may differ not only between countries and regions, but possibly also between human immunodeficiency virus (HIV)Yinfected and noninfected women. METHODS : In a population with high HIV prevalence, human papillomavirus (HPV)Ytype infections detected with DNA analyses were reported in a cohort of 299 women diagnosed with invasive cervical cancer. RESULTS : One hundred fifty-four women tested HIV negative, 77 tested HIV positive, and HIVstatuswas unknown for 68women. Themean age forHIV-positivewomenwas 41.3 years, and that for HIV-negative women was 55.8 years (P G 0.001). Ninety-two percent of women tested HPV-DNA positive. Human papillomavirus types 16 and/or 18 were present in 62% of HIV-negative women and 65% of HIV-positive women. The 5 most common HPV types in HIV-positive women were, in decreasing frequency, HPV 16, 18, 45, 33, and 58. In HIVnegative women, the most common HPV types were HPV 16, 18, 35, and 45, followed by HPV 33 and 52.Human papillomavirus type 45wasmore likely in the HIV positive compared with theHIV negative (odds ratio, 3.07; 95%confidence interval, 1.07Y8.77).TheHIV-positive women had more multiple high-risk HPV-type infections than did the HIV-negative women (27% vs 8%, P = 0.001). CONCLUSIONS : A high number of women in South Africa with cervical cancer are HIV positive. Without viral cross-protection, HPV vaccines should prevent around 65% of cervical cancers in this population. Human papillomavirus type 45 infection is significantly linked to HIV and important for future vaccine developments.