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Assessment of high-risk human papillomavirus infections and associated cervical dysplasia in HIV-positive pregnant women in Germany: a prospective cross-sectional two-centre study

  • Gynecologic Oncology
  • Published:
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Abstract

Purpose

Invasive cervical cancer (ICC) is associated in nearly 100% with persistent high-risk Human Papillomavirus (HR-HPV) infection. ICC is still one of the leading causes for cancer mortality in women worldwide. The immunosuppressive influence of Human Immunodeficiency Virus (HIV) and the immunocompromised period of pregnancy due to tolerance induction against the hemiallogeneic fetus, are generally risk factors for acquisition and persistence of HR-HPV infections and their progression to precancerous lesions and HPV-associated carcinoma.

Methods

Overall, 81 pregnant women living with HIV (WLWH) were included. A medical history questionnaire was used to record clinical and HIV data. Participants received cervicovaginal cytological smear, colposcopy and HPV testing. HPV test was performed using BSGP5+/6+ PCR with Luminex read-out. The HR-HPV genotypes 16, 18, 31, 33, 45, 52, 58 were additionally grouped together as high-high-risk HPV (HHR-HPV) for the purpose of risk-adapted analysis.

Results

HR-HPV prevalence was 45.7%. Multiple HPV infections were detected in 27.2% of participants, of whom all had at least one HR-HPV genotype included. HR-HPV16 and HR-HPV52 were the most prevalent genotypes and found when high squamous intraepithelial lesion (HSIL) was detected by cytology. HIV viral load of ≥ 50 copies/ml was associated with higher prevalence of HR-HPV infections. Whereas, CD4 T cells < 350/µl showed association with occurrence of multiple HPV infections. Time since HIV diagnosis seemed to impact HPV prevalence.

Conclusion

Pregnant WLWH require particularly attentive and extended HPV-, colposcopical- and cytological screening, whereby clinical and HIV-related risk factors should be taken into account.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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Authors and Affiliations

  1. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Obstetrics, Augustenburger Platz 1, 13353, Berlin, Germany

    Charlotte K. Metz, Jan-Peter Siedentopf, Katharina Weizsaecker, Wolfgang Henrich & Irena Rohr

  2. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Gynecology, Laboratory for Gynaecological Tumor Immunology, HPV Laboratory, Augustenburger Platz 1, 13353, Berlin, Germany

    Anna S. Skof, Jalid Sehouli & Andreas M. Kaufmann

  3. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany

    Pimrapat Gebert

  4. Ludwig-Maximilians-University (LMU), University Hospital, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377, Munich, Germany

    Fabian Weiss & Irene Alba Alejandre

  5. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Social Medicine, Epidemiology and Health Economic, Luisenstraße 57, 10117, Berlin, Germany

    Michaela Heinrich-Rohr

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  1. Charlotte K. Metz
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Contributions

The first draft of the manuscript was written by CKM. Project development, data analysis, data collection and manuscript editing were performed by CKM, ASS, AMK and IR. JS and WH were responsible for project development and provided contributions to project implementation. J-PS, KW, IA-A and FW contributed by data collection. J-PS performed editing of the manuscript. PG and MH-R performed data analysis. All authors checked and agreed to the final manuscript.

Corresponding author

Correspondence to Irena Rohr.

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This study was conducted according to the principles of the Declaration of Helsinki. An ethics approval was necessary and given from ethical committees in Berlin (IRB number EA4/098/19) and Munich (IRB number 20-1040).

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Metz, C.K., Skof, A.S., Sehouli, J. et al. Assessment of high-risk human papillomavirus infections and associated cervical dysplasia in HIV-positive pregnant women in Germany: a prospective cross-sectional two-centre study. Arch Gynecol Obstet 308, 207–218 (2023). https://doi.org/10.1007/s00404-022-06890-w

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