The association between the human papillomavirus (HPV), dysplasia of the uterine cervix and progression of the human immunodeficiency virus
Description
Objectives. To investigate the association between HPV infection, cervical dysplasia (CD) and progression of HIV Methods. All eligible adult and adolescent women attending a public HIV outpatient clinic from January 1990 to October 1994 were followed. Demographic and clinical information was abstracted from the medical records. The Kaplan-Meier product limit and Cox proportional hazards model were utilized to evaluate the association between HPV infection at entry into the cohort, ever evidence of HPV infection, and CD on progression of HIV. Two distinct models were used; time to death and time to AIDS Results. (1) Time to death: After adjusting for CD4 counts, pneumocystis carinni pneumonia (PCP) prophylaxis and age, women with CD were 1.8 times more likely to die (95% CI = 0.9, 3.5), women with HPV at entry were 3.3 times more likely to die (95% CI = 1.4, 8.3), and women ever diagnosed with HPV were 1.6 times more likely to die (95% CI = 0.8, 3.3). In the Cox analysis, there was no consistent association between HPV infection, CD and survival. (2) Time to AIDS: After adjusting for CD4 counts, PCP prophylaxis and age, women with CD were 2.1 times more likely to develop AIDS (95% CI = 1.4, 4.7), women with HPV at entry were 4.2 times more likely to develop AIDS (95% CI = 1.6, 10.9), and women ever diagnosed with HPV were 2.5 times more likely to develop AIDS (95% CI = 1.3, 5.0). In the Cox analysis, women with CD (HR 1.7, 95% CI = 1.0, 2.8), HPV at entry (HR 2.4, 95% CI = 1.2, 4.6), and ever HPV infection (HR 1.6, 95% CI = 0.9, 2.8) progressed to AIDS more rapidly Conclusion. Evidence of HPV infection and SIL in women with HIV appears to be associated with progression time to AIDS but not death