Clinical and Molecular Genetic Analyses of Multiple Human Papillomavirus Types Among HIV-1-Infected Women in Hawaii

             Human papillomaviruses (HPV) are casually associated with neoplastic lesions of cutaneous and mucosal epithelia, and specific types of HPV are known to cause cervical cancer.  In 1993, the Centers for Disease Control and Prevention (CDC) designated cervical cancer as an AIDS-defining illness in HIV-1-infected women.  However, limited data are available on the natural history of HPV persistence in HIV-1-infected women.  To determine the spectrum of HPV types, as well as prevalence of cervical dysplasia, in HIV-1-infected women, we have studied a cohort of 29 women (22 Caucasian, 7 Asian/Pacific Islander; mean age, 36 years; age range, 21-48 years) from Hawaii over a 30-month period.  A 450-nucleotide region spanning the major capsid protein-encoding L1 gene of HPV was amplified from CVL specimens by PCR using the degenerate primer pair, MY09 and MY11.  Of the 29 women, 8 (28%) had abnormal Pap smears, and 17 (59%), including 4 women who were CSW, had detectable HPV sequences in CVL by PCR.  HPV DNA was detected in CVL samples from more than one 6-month time point in 9/17 (53%) women (two women were PCR positive at three consecutive time points).  Multiple HPV types were identified, including HPV 6b,18, 31, 53, 61, 62, 66, and three unknown types.  In four women, the same HPV type, with low intra-strain sequence divergence (nil-0.5%), was found at two time points.  The three untypable HPV sequences exhibited 98.5%, 97.9% and 98.7% homology to HPV MM7, HPV LVX82 and HPV CP4173, respectively.  Two women were dually infected: HPV 53 and HPV 6B; HPV 61 and HPV CP4173.  A strong association was demonstrated between HPV infection and multiple sexual partners (p < 0.0001).  Although none of the women had cervical cancer, 28% had abnormal Pap smear, and in this small cohort, HPV persistence in CVL (53%) was common.  It will be informative to investigate if age-specific HPV persistence and progression to cervical cancer occurs more frequently in HIV-1-infected women.

Nerurkar, V.R., Hoffmann, P.R., Shikuma, C.M., Dashwood, W.M., Milne, C.I.P., Kindrick, A.V., and Yanagihara, R.:  Multiple human papillomaviruses among HIV-1-infected women in Hawaii:  Clinical and molecular genetic analyses.  Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1997;14:A50.

Nerurkar, V.R., Ieong, A., Hoffmann, P.R., Shikuma, C.M., Dashwood, W-M., Milne, C.I.P., Kindrick, A.V., and Yanagihara, R.:  Clinical and molecular genetic analyses of multiple human papillomavirus types among HIV-1-infected women in Hawaii.  Hawaii Medical Journal  (in preparation).

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