Human papillomavirus type 16 viral load in relation to HIV infection, cervical neoplasia and cancer in Senegal

• The importance of human papillomavirus (HPV) viral load in the pathogenesis of cervical cancer among HIV-infected and HIV-uninfected women has not yet been established.
• In our study of women including those with cancer, HPV-16 viral load was associated with a higher likelihood of cervical abnormalities.
• Higher viral load among HIV-infected individuals may indicate that HIV infection influences HPV viral replication factors.

Background: The importance of human papillomavirus (HPV) viral load in the pathogenesis of cervical cancer among HIV-infected and HIV-uninfected women has not yet been established. Methods: In this cross-sectional study, HPV-16 viral loads were measured using previously-collected and frozen cervical swab samples from 498 HPV-16 positive Senegalese women (368 HIV-seronegative, 126 HIV-1 and/or HIV-2 seropositive). The real-time polymerase chain reaction assay was used to quantify HPV-16 E7 copy number normalized by human cellular DNA (β-actin), and viral loads were log10 transformed. Associations between HPV-16 viral load, degree of cervical abnormality, and HIV status were assessed using multinomial and linear regression methods. Results: Compared to women with normal cytology, the likelihood of CIN1 (ORa: 1.21, 95% CI 0.93–1.57), CIN2-3 (ORa: 2.38, 95% CI 1.72–3.29) and cancer (ORa: 2.12, 95% CI 1.52–2.96) was found to increase for each 1-unit log10 increase in HPV-16 viral load. Compared to HIV-negative women, HIV-positive women had higher average HPV-16 viral load values (βa: 0.39, 95% CI 0.03–0.75), even after accounting for degree of cervical abnormality. Conclusion: In our study of women including those with cancer, HPV-16 viral load was associated with a higher likelihood of cervical abnormalities. However, substantial overlaps across categories of disease severity existed. Higher viral load among HIV-infected individuals may indicate that HIV infection influences HPV viral replication factors.