60PV Related Lesions in HIV Positive Subjects on HAART: Study of Viral Markers of Cervical Neoplasia Progression

As for other slow evolving tumors, the risk of HPV related ano-genital carcinoma, has increased in the era of HAART. We studied HPV related parameters to identify markers of progression and HIV/HPV infections interaction.

HIV pos women (N = 410) were followed since 1995 in a longitudinal study. Each one undergo periodic (6–12 months) colposcopy, PAP smear, biopsy if needed, and cervical sampling for HPV testing. HIV related parameters (CD4, HIV-RNA, ART) are recorded and related to cervical disease. HPV typing is performed by reverse hybridisation assays, viral load by in-house real time PCR and viral expression by E6/E7 mRNA detection. The Mann-Whitney rank sum test for non-parametric data and the association between discrete variables by Chi-square test of Fisher exact test were applied.

Prevalence of high risk HPV (HR-HPV) is 59.3%; high grade lesions (HgSIL) are 8.9% and low grade (LgSIL) 24%. Subjects with lower nadir of CD4 count in their HIV story, show increased rates of these values independently by the efficacious use of HAART. Sixty one pt (15%) underwent surgical resection of high grade lesions or cervical K. HPV load was prospectively studied in 16 of these cases (HgSIL) and 22 HR-HPV positive controls without cervical lesions. In the cervical brush collected at diagnosis, all cases had an HPV load significantly higher then controls (p = 0.0004). Decreasing HPV load were observed when comparing pre- and post-surgery samples (p < 0.0001). The number and type/s of HPV strains were not statistically different between cases and controls. Multiple infections were detected at baseline in 43.7% of cases and 54.5% of the controls, in 87.5% of the cone biopsies and in 56.25% of the post-treatment sample of the cases.

Persistence of HR-HPV as a key marker in the development of cervical lesions is poorly informative in HIV positive women due to its high frequency and coinfection with multiple HR-HPV types. Novel clinical biomarkers to identify subjects at true risk for the development of cervical lesions may include viral burden: both total and type specific. High level of HPV DNA is in fact detected in the lesions and is drastically reduced by their removal.

Affiliations

1. IRCCS Hospital San Raffaele, Milano, Italy

   • Flavia Lillo
   • , Davide Ferrari
   • , Adriano Lazzarin
   •  & Caterina Uberti-Foppa

Corresponding author

Correspondence to Flavia Lillo.

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