Human papillomavirus infection and cervical dysplasia in HIV-positive women: potential role of the vaginal microbiota

Autor: van de Wijgert, Janneke HHM, Gill, A Christina, Chikandiwa, Admire, Verwijs, Marijn C, Kelly, Helen A, Omar, Tanvier, Delany-Moretlwe, Sinead, Segondy, Michel, Francis, Suzanna, Darby, Alistair C, Mayaud, Philippe, Grp, HARP Study
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
cervical cancer
Uterine Cervical Neoplasms
South Africa
0302 clinical medicine
HIV Seropositivity
Immunology and Allergy
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Papillomaviridae
Early Detection of Cancer
16S rRNA gene sequencing
education.field_of_study
Lactobacillus crispatus
biology
Middle Aged
3. Good health
Infectious Diseases
Vagina
Female
women
Adult
lactobacilli
medicine.medical_specialty
HPV
Immunology
Population
Cervical intraepithelial neoplasia
03 medical and health sciences
Internal medicine
medicine
Journal Article
Humans
education
Vaginal Smears
business.industry
cervical intraepithelialneoplasia
vaginal dysbiosis
Papillomavirus Infections
HIV
Uterine Cervical Dysplasia
medicine.disease
biology.organism_classification
Logistic Models
030104 developmental biology
Dysplasia
Hormonal contraception
Case-Control Studies
Relative risk
Dysbiosis
business
vaginalmicrobiota
Zdroj: AIDS
AIDS, 34(1), 115. Lippincott Williams and Wilkins
ISSN: 0269-9370
Popis: 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 (N = 304 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 2x300 bp) 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, P = 0.019], 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, P = 0.026). Compared to women without CIN2+, but with hrHPV at both visits, women with incident CIN2+ had increased Simpson diversity (RRR 7.352, P = 0.028) 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.
Databáze: OpenAIRE
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