Incidence and Prevalence of Human Papillomavirus Infection to Predict Outcomes from HPV-Based Cervical Cancer Screening in Women and People with a Cervix Living with HIV.

BACKGROUND

Human papillomavirus (HPV) testing has been implemented in many organized cervix screening programs; however, understanding how this screening methodology affects rates of colposcopy and further follow-up procedures remains underexplored, especially among women with HIV. In the absence of HPV screening program data in British Columbia (BC), Canada, we sought to determine HPV prevalence and estimates for colposcopies among a cohort of women with HIV using the BC Cervix Screening algorithm.

SETTING

HPV data were collected and analyzed from a prospective HPV vaccine immunogenicity cohort study of women with HIV from 14 sites of HIV care across Canada from 2008 to 2015.

METHODS

HPV data were obtained during the screening (month -3), baseline (month 0), month 12, and month 24 time points (Linear Array assay). Participant demographic and clinical characteristics (CD4 + count, HIV viral load, etc.) were assessed to determine associations between HPV prevalence and estimates for colposcopy using rate ratios and 95% confidence intervals.

RESULTS

Overall, 47.2% of participants had oncogenic HPV detected at screening which would result in a colposcopy referral. In total, 15.9% of participants had oncogenic HPV detected at screening, month 12, and month 24 time points, which would result in 3 consecutive referrals to colposcopy. Participants with repeat oncogenic HPV detected were less likely to have a suppressed HIV viral load compared with participants without oncogenic HPV detected.

CONCLUSIONS

Results of this study suggest that HPV testing will result in a high proportion of referrals to colposcopy and follow-up procedures among women with HIV, which will require preparation and planning. Further work is needed to provide the appropriate support and education for women with HIV when incorporating HPV testing into cervix screening programs.