Human papillomavirus infection and cervical dysplasia in HIV-positive women: potential role of the vaginal microbiota.
AIDS
; 34(1): 115-125, 2020 01 01.
Article
em En
| MEDLINE
| ID: mdl-31567164
ABSTRACT
OBJECTIVES:
To assess the associations between microbiological markers of vaginal dysbiosis and incident/cleared/type-swap/persistent high-risk human papillomavirus (hrHPV) infection; and incident/cured/cleared/persistent high-grade cervical intraepithelial neoplasia (CIN2+) while controlling for persistent hrHPV infection.DESIGN:
Two nested case-control studies (Nâ=â304 and 236) within a prospective cohort of HIV-positive women in Johannesburg, South Africa.METHODS:
Participants were examined for hrHPV type (INNO-LiPA), cervical dysplasia (histology), and vaginal microbiota (VMB) composition (V3-V4 Illumina HiSeq 2x300âbp) at baseline and endline, a median of 16 months later.RESULTS:
Women with incident hrHPV compared to those who remained hrHPV-negative were less likely to have an optimal Lactobacillus crispatus or jensenii-dominated VMB type at end-line [relative risk ratio (RRR) 0.125, Pâ=â0.019], but not at baseline. Having different hrHPV types at both visits was associated with multiple anaerobic dysbiosis markers at baseline (e.g. increased bacterial vaginosis-associated anaerobes relative abundance RRR 3.246, Pâ=â0.026). Compared to women without CIN2+, but with hrHPV at both visits, women with incident CIN2+ had increased Simpson diversity (RRR 7.352, Pâ=â0.028) and nonsignificant trends in other anaerobic dysbiosis markers at end-line but not baseline. These associations persisted after controlling for age, hormonal contraception, and CD4 cell count. Current hormonal contraceptive use (predominantly progestin-only injectables) was associated with increased CIN2+ risk over-and-above persistent hrHPV infection and independent of VMB composition.CONCLUSIONS:
hrHPV infection (and/or increased sexual risk-taking) may cause anaerobic vaginal dysbiosis, but a bidirectional relationship is also possible. In this population, dysbiosis did not increase CIN2+ risk, but CIN2+ increased dysbiosis risk. The CIN2+ risk associated with progestin-only injectable use requires further evaluation.
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
/
Saude_da_mulher
/
Colo_do_utero
/
Tipos_de_cancer
/
Colo_do_utero
/
Outros_tipos
Base de dados:
MEDLINE
Assunto principal:
Vagina
/
Displasia do Colo do Útero
/
Neoplasias do Colo do Útero
/
Soropositividade para HIV
/
Infecções por Papillomavirus
/
Disbiose
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Adult
/
Female
/
Humans
/
Middle aged
País/Região como assunto:
Africa
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2020
Tipo de documento:
Article