Cervical abnormalities, human papillomavirus, and human immunodeficiency virus infections in women in Malawi

Cervicovaginal lavage samples and Pap smears were obtained from 284 women in Malawi to evaluate the association between human papillomavirus (HPV) and human immunodeficiency virus (HIV) infections. Squamous intraepithelial lesions were present in 15% (17/116) of HIV-seropositive and 7% (11/152) of HIV-seronegative women (P = .05) and in 23% (19/83) of HPV polymerase chain reaction (PCR)-positive and 4% (6/156) of HPV PCR-negative women (P < .001). HPV DNA was detected in 23% of HIV-uninfected women but in 60% of HIV- infected women with <300 CD4 cells/mm3 (P < .002). High-risk HPV types 16 and 18 constituted half of the identified types. HPV DNA in previously HPV- positive women was detected more often in HIV-seropositive (75%) than in - seronegative women (23%) (P = .02). HIV-infected women had twice the risk of abnormal cervical cytology than uninfected ones and were more likely to have persistent HPV infections. Early detection of HPV and regular monitoring of HPV-related cervical lesions may be important in HIV-infected women.