among HIV-positive Thai women at the ... Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 2. ... 77% were on antiretroviral treatment (ART) for a.
Abstract No.TUPE11
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Risk factors for cervical infection with high-risk human papillomavirus among HIV-positive Thai women at the Thai Red Cross Anonymous Clinic Tippawan Pankam1,5, Nipat Teeratakulpisan1, Jiranuwat Barisri1, Piyanee Rodbamrung 1, Mana Khongphatthanayothin1, Sunee Sirivichayakul2, Reshmie Ramautarsing 3,4, Nittaya Phanuphak1, Ramida Watanapokasin5, Praphan Phanuphak1, 2, Surasith Chaithongwongwatthana6 1. Thai Red Cross AIDS Research Centre, Bangkok, Thailand 2. Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 3. The HIV Netherlands Australia Thailand Research Collaboration (HIVNAT), Bangkok, Thailand 4. Centre for Poverty-related Communicable Diseases (CPCD), Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 5. Department of Biochemistry, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand 6. Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Background • Cervical cancer is the second most common cancer among women worldwide. • Persistence of high risk human papillomavirus (HR-HPV) infection is the major risk factor for the development of cervical intraepithelial neoplasia (CIN) and cancer.
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• HPV is a non-enveloped, double-stranded, circular DNA virus with an icosahedral capsid, the genome is approximate 8000 base pairs and compose of early and late proteins. • Immunosuppression from HIV infection may enhance the risk of CIN and cervical cancer
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Methods Study population • HIV-positive women not diagnosed with cervical disease in the last 6 months were enrolled into the cervical dysplasia study at the Thai Red Cross Anonymous Clinic between June 2009 - October 2010. • All women received history taking, gynecological examination including colposcopy and cervical tissue biopsy of abnormal lesions, cervical sample collection for cytology and HR-HPV testing, CD4 count and plasma HIV-RNA testing (Figure 1). www.ias2011.org
Figure 1 Flow Diagram of the cervical dysplasia study HIV-positive women Enrolled Written inform consent history taking Gynaecological examination colposcopy
cervical sample collection HPV testing Blood collection HIV testing CD4 testing
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HR-HPV testing
• AMPLICOR Human Papilloma Virus Test, Roche Diagnostics, USA were used to detect the presence of high risk HPV genotype (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). • Process of HR-HPV testing start with HPV DNA extraction from cervical cell collected,then amplifed by specific primer followed by hybridization. PCR product is transferred into micro well plate coated with HPV high probes and detect products by colorimetric determination (Figure 2). www.ias2011.org
Figure 2 HR-HPV detection process Cervical cell collection
HPV DNA extaction
PCR amplification
Hybridization
Detection
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Results • 260 HIV-infected women were enrolled. • Mean (SD) age was 36.3 (5.6) years and Mean CD4 count was 521 (205.6) cells/mm3. • 77% were on antiretroviral treatment (ART) for a mean duration of 72 (33.1) months. • 22.1 % had detectable plasma HIV-RNA (>50 copies/ml). • Cervical HR-HPV infection was detected in 92 (35.4%) women.
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• Abnormal cervical cytology from atypical squamous cells of undetermined significance and above was identified in 17 (6.9%) women. • 10 (3.8%) had CIN II, III by biopsy under colposcopy. • Cervical HR-HPV infection was found to be associated with abnormal cervical cytology (p
