Background: Behaviourally HIV-infected adolescent females are at higher risk for abnormal cervical cytology and HPV
infection compared to those who are uninfected, but data on perinatally HIV-infected adolescent females are lacking.
Methods: Cervical cytology, HPV infection and E6/E7 mRNA were assessed in sexually active 12-24-year-old adolescent
females: perinatally HIV-infected (group 1, n =40), behaviourally HIV-infected (group 2, n =10), and HIV-uninfected
(group 3, n =10).
Results: Median age was lower in group 1 (18 years) than in groups 2 (24 years) and 3 (20.5 years) (P <0.001), and
median time since sexual debut was shorter: 2 vs 5 vs 4 years (P <0.001). More trial participants in group 1 than group 2
were on antiretrovirals (90% vs 70%; P <0.001). Abnormal cervical cytology (atypical squamous cells of undetermined
significance and higher) was observed in 30% (group 1), 40% (group 2) and 30% (group 3) (P =0.92), whereas high-risk
HPV infection was observed in 45%, 45% and 40%, respectively (P =1.00). Positive E6/E7 mRNA was found in 28% of
group 1, but not in other groups. High-risk HPV infection predicted abnormal cytology in all groups [OR 6.77, 95%
confidence interval (CI) 1.99-23.0; P =0.001). Additionally, plasma HIV RNA ≥50 copies/mL (OR 13.3, 95% CI
1.16-153.06; P =0.04) predicted abnormal cytology in HIV-infected adolescent females.
Conclusions: Despite the younger age and shorter time since sexual debut, cervical cytological abnormalities and HPV
infection were as common in perinatally HIV-infected as in behaviourally infected and uninfected adolescents. HPV
vaccination, pre-cancer screening and antiretroviral treatment in HIV-infected female adolescents should be implemented
to minimise the risk of cervical cancer.
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