Effect of Human Immunodeficiency Virus Infection on Human Papillomavirus Clearance among Women in Senegal, West Africa

Thesis (Master's)--University of Washington, 2021Background. Persistent infection with human papillomavirus (HPV) is associated with development of cervical-related disease. Methods. A total of 174 Senegalese women completed health questionnaires and were tested for Human Immunodeficiency Virus (HIV) upon enrollment, as well as were tested HPV at baseline and during follow up. The 2-year cumulative incidence of clearance of type-specific HPV infection was estimated by Kaplan-Meier methods. Marginal Cox proportional hazards models stratified by incident/prevalent HPV infection were used to evaluate the effect of HIV status and type on HPV clearance. Results. Incident HPV infections in HIV-positive women were 34% less likely to be cleared than those in HIV-negative women (adjusted HR=0.66, 95% CI: 0.44-0.99), but the association was not significant for prevalent HPV infections (adjusted HR=1.16, 95% CI: 0.81-1.67). For HIV-positive women, we observed no significant association between HIV type and clearance of HPV infection among incident HPV infections (HIV-2 vs HIV-1: adjusted HR=1.61, 95% CI: 0.93-2.80; Dually infected vs HIV-1: HR=1.50, 95% CI: 0.87-2.57) and among prevalent HPV infections (HIV-2 vs HIV-1: adjusted HR=0.77, 95% CI: 0.23-2.66; Dually infected vs HIV-1: HR=0.71, 95% CI: 0.36-1.38). Incident HPV infections in women with CD4 cell counts ≤500 were 37% less likely to be cleared than those in women with CD4 cell counts >500 (adjusted HR=0.63, 95% CI: 0.41-0.97), but the association was not significant for prevalent HPV infections (adjusted HR=0.87, 95% CI: 0.46-1.63). Conclusions. HIV infection reduces the likelihood of clearance of incident HPV infection. CD4 cell count is considered as a more effective predictor of HPV clearance than HIV type