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

van de Wijgert, Janneke HHM ORCID: 0000-0003-2728-4560, Gill, A Christina, Chikandiwa, Admire, Verwijs, Marijn C, Kelly, Helen A, Omar, Tanvier, Delany-Moretlwe, Sinead, Segondy, Michel, Francis, Suzanna, Darby, Alistair C ORCID: 0000-0002-3786-6209
et al (show 1 more authors) (2020) Human papillomavirus infection and cervical dysplasia in HIV-positive women: potential role of the vaginal microbiota. AIDS, 34 (1). pp. 115-125.

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<h4>Objectives</h4>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.<h4>Design</h4>Two nested case-control studies (N = 304 and 236) within a prospective cohort of HIV-positive women in Johannesburg, South Africa.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

Item Type: Article
Uncontrolled Keywords: 16S rRNA gene sequencing, cervical cancer, cervical intraepithelial neoplasia, HIV, HPV, lactobacilli, South Africa, vaginal dysbiosis, vaginal microbiota, women
Depositing User: Symplectic Admin
Date Deposited: 11 Oct 2019 08:16
Last Modified: 19 Jan 2023 00:23
DOI: 10.1097/QAD.0000000000002381
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