Cervical HPV infection among HIV-infected prostitutes addicted to hard drugs

An investigation into the prevalence of human papilloma virus (HPV) infection, abnormal cervical cytology and the relationship between HIV-and HPV infection was done in a group of intravenously (IV) and non-IV drug-using prostitutes. From July 1991 through May 1992, hard drugaddicted prostitutes attending a sexually-transmitted-disease (STD) clinic in Amsterdam were recruited. A questionnaire was administered to obtain demographic characteristics, and medical and STD history. Apart from routine STD examination, cervical scrapes for cytology and samples for HPV DNA detection by polymerase chain reaction (PCR) were collected. Some of the women included in this study also participated in HIV studies among drug users. Their data on HIV- and immunologic status could be combined. A total of 121 women entered the study; 25 women were HIV-seropositive, 44 women were HIV-negative, and the HIV status of 52 women was unknown. All 25 HIV-positive women had normal Pap smears, two of the 44 HIV-negative women had a Pap smear III A, and in the HIV-unknown group, two women with Pap III A and one with Pap III B were found. Eight of the 25 (32%) HIV-positive women were HPV DNA-positive, three of the 44 (7%) HIV-negative women and 10/52 (19%) of the HIV-unknown group. Logistic regression analysis showed that in the total group, presence or cervical HPV DNA was associated with HIV infection (order ratio [OR] for HIV-positives 7.8, 95% confidence interval [CI] 1.8 to 34.6) and with diagnosis of condylomata acuminata at entry to the study (OR 7.5, 95% CI 1.5 to 36.5). The mean of the calculated minimal duration of HIV infection was 6.5 years for HPV-positive women vs. 4.2 years for the HPV-negative women (P = 0.001, OR 1.8 per year, 95% CI 1.1 to 3.2). The difference of CD4 T-cell counts between HPV-positive and negative women (all HIV-positive) was statistically not significant (557/mm³ vs. 486/mm³). Our data indicate that in this group of hard drug-addicted prostitutes, HIV infection is associated with a higher prevalence of HPV infection but not with a higher rate of abnormal cervical cytology. In the group of HIV-infected women, an association between CD4 T-cell counts and HPV infection was not established.