Persistent infection with high-risk human papillomavirus (hrHPV) is a critical step in cervical carcinogenesis. We report on type-specific hrHPV persistence, clearance and incidence among screen-positive Rwandan women living with HIV (WLWH). This was a nested analysis from a large cervical cancer screening study of ~ 5000 Rwandan WLWH. Women who tested positive for hrHPV and/or visual inspection with acetic acid were referred to colposcopy. For a subset of women (n = 298) who were ≥ 6 months delayed in receiving colposcopy, we tested their screening and colposcopy visit specimens using the AmpFire HPV genotyping assay that tests 14 hrHPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) individually. The mean, median (interquartile range [IQR]) and range of time between the screening and colposcopy visits were 644, 650 (490–820.5) and 197–1161 days, respectively. Mean, median (IQR) and range of age at the screening visit were 38, 37 (34–43) and 30–54 years, respectively. Two-hundred eighty-three (95.0%) had CD4 count (cells per mm3) data available at baseline with mean, median (IQR) and range of 592, 513 (346–717) and 0–7290, respectively. Two-hundred thirty-five WLWH were positive for at least one hrHPV type at the screening visit, of whom 50.2% had at least one HPV type-specific infection persist; 37.2% of all HPV infections detected at the screening visit persisted. Compared to all other HPV types in aggregate, HPV16 (vs. non-HPV16 types) (47.7%, p = 0.03) and HPV33 (vs. non-HPV33 types) (56.7%, p = 0.03) were significantly more likely, and HPV39 (vs. non-HPV39 types) (6.7%, p = 0.01), HPV51 (vs. non-HPV51 types) (15.6%, p < 0.01), and HPV66 (vs. non-HPV66 types (17.9%, p = 0.04) were significantly less likely, to persist. Lower CD4 counts were associated with having any persistent hrHPV infection (ptrend = 0.04) and multiple persistent hrHPV infections (ptrend = 0.04). There is a significant proportion of WLWH with persistent hrHPV infection, emphasizing the need to vaccinate them against HPV prior to becoming sexually active.

中文翻译：

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筛查阳性的卢旺达 HIV 感染妇女中高危 HPV 的类型特异性持续性、清除率和发病率

持续感染高危人乳头瘤病毒 (hrHPV) 是宫颈癌发生的关键步骤。我们报告了筛查阳性的卢旺达 HIV 感染妇女 (WLWH) 中特定类型的 hrHPV 持续性、清除率和发病率。这是一项针对约 5000 卢旺达 WLWH 的大型宫颈癌筛查研究的嵌套分析。对 hrHPV 检测呈阳性和/或用醋酸进行肉眼检查的女性被转诊至阴道镜检查。对于接受阴道镜检查延迟 ≥ 6 个月的女性子集（n = 298），我们使用 AmpFire HPV 基因分型分析测试了她们的筛查和阴道镜检查样本，该分析测试了 14 hrHPV 类型（16、18、31、33、35、 39、45、51、52、56、58、59、66 和 68)。筛查和阴道镜检查之间的平均数、中位数（四分位距 [IQR]）和时间范围分别为 644、650 (490-820. 5）和197-1161天，分别。筛选访问时的平均年龄、中位数 (IQR) 和年龄范围分别为 38、37 (34-43) 和 30-54 岁。283 (95.0%) 在基线时有 CD4 计数（每 mm3 的细胞数）数据，平均值、中位数 (IQR) 和范围分别为 592、513 (346-717) 和 0-7290。235 名 WLWH 在筛查访视时对至少一种 hrHPV 类型呈阳性，其中 50.2% 的人持续存在至少一种 HPV 类型特异性感染；在筛查访问中检测到的所有 HPV 感染中，有 37.2% 持续存在。总体而言，与所有其他 HPV 类型相比，HPV16（与非 HPV16 类型）（47.7%，p = 0.03）和 HPV33（与非 HPV33 类型）（56.7%，p = 0.03）的可能性显着增加，并且HPV39（与非 HPV39 类型相比）（6.7%，p = 0.01）、HPV51（与非 HPV51 类型相比）（15.6%，p < 0.01）和 HPV66（与 非 HPV66 类型（17.9%，p = 0.04）持续存在的可能性显着降低。较低的 CD4 计数与任何持续性 hrHPV 感染（ptrend = 0.04）和多次持续性 hrHPV 感染（ptrend = 0.04）相关。有很大比例的 WLWH 患有持续性 hrHPV 感染，强调需要在性活跃之前为他们接种 HPV 疫苗。