Trichomonas vaginalis in HIV-Infected women: A Risk Factor for High Risk Human Papillomavirus

Objective: Women with Trichomonas vaginalis (TV) are four times as likely to have high-risk human papilloma virus (HRHPV). TV is more common in HIV-infected women and associated with HIV transmission. This study aimed to describe the association between TV and HRHPV in HIV-infected women undergoing cervical cancer screening. Methods: We reviewed the records of 329 HIV-infected women presenting for cervical cancer screening. Chi-squared analysis was used to compare proportions of disease in women with and without HRHPV. Univariate and multivariate logistic regression analyses were used to determine factors associated with HRHPV. Results: Of women screened for HRHPV, over half were infected (114/210). TV infection was present in 57/257 screened. TV was associated with a 4-fold increase risk of HRHPV (OR, 3.8; 95% CI 1.6-9). Current abnormal pap (OR, 15.9; 95% CI 8.1-31.3) and AIDS (OR, 6.1: 95% CI 2.6-14.5) were the most significant risk factors for HRHPV infection. Conclusions: TV and HRHPV are common infections among HIV-infected women. TV was a significant risk factor for HRHPV infection. The consequence of untreated TV infection may be persistent HRHPV infection and risk of cervical cancer. Women Health Int Volume 1 • Issue 1 • 3000102 Patient characteristics and results of screening tests at the time of the most recent cervical cancer screening exam were recorded. These included: current pregnancy, cervical cytology and histology, HR HPV infection determined by PCR (Cervista HPV high risk assay, Hologic, Inc.) or histology demonstrating cervical intraepithelial neoplasia, bacterial vaginosis (BV) screening, and Trichomonas screening. Any new STI diagnosis at the time of cervical cancer screening was noted. BV screening was performed using Amsel’s criteria or gram stain (Nugent’s score ≥7) [22]. A diagnosis of BV by Amsel’s criteria consists of 3 of the following 4 findings: vaginal discharge, pH greater than 4.5, positive whiff test, and presence of clue cells on microscopy [23]. Trichomonas screening was considered positive if organisms were identified by Gen-Probe APTIMA Trichomonas vaginalis assay (San Diego, CA), microscopy, culture (InPouchTM TV test, BioMed Diagnostics San Jose, CA), or cervical cytology (ThinPrep® Imaging System,Hologic Inc., MA). To assess HIV status at time of the cervical cancer screening exam, a subject’s HIV RNA viral load (copies/ml) and CD4 cell counts (cells/mm3) within the last year were noted. RNA viral load was recorded as zero copies/ml if the HIV RNA viral load was undetectable using Abbott M2000 Real time PCR test (Abbott Park, Illinois). For subjects on anti-retroviral therapy (ARVs) and/or opportunistic infection prophylaxis (OIP), therapeutic regimen at the time of the most recent cervical cancer screening exam was recorded.