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PapilloV: Human Papillomavirus (HPV) infection and Cervical lesions in HIV infected women in  Thailand: a prospective study

In Thailand, cervical cancer it is the second most common cancer among women and causes more than 5,000 deaths each year. HIV infected women are more at risk of HPV infection and more susceptible to develop cervical lesions and ultimately cancer..

Human Papilloma Virus (HPV) infection has been identified as the main risk factor for the development of cervical cancer. Among more than 100 HPV described in the literature, 13 are considered at high risk (HR-HPV) by WHO, especially HPV 16 and 18. Those two genotypes account for more than 70% of cervical cancers worldwide.

The main objectives of the PapilloV study among HIV-infected women in Thailand are to:
  • Assess the frequency of HPV infections, especially HR-HPV
  • Assess the frequency of pre-cancerous lesions of the cervix
  • Develop an algorithm for the diagnosis of cervical cancer combining HPV screening and pap-smear.
From 2012 to 2013, the PapilloV study enrolled 829 HIV-infected women in 24 hospitals throughout Thailand. Women underwent HPV and pap-smear test yearly. In case of abnormal pap-smear or in the presence of HPV-HR, women were further referred for a colposcopy and cervical biopsy if indicated and received appropriate treatment if necessary.
​The study is now completed with 78% of the 829 women recruited followed up until the end of the study, and 90% women who underwent at least two visits.

Publications:
  • Delory T, et al., Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand, J Infect (2017), http://dx.doi.org/10.1016/j.jinf.2017.02.007
  • Clifford GM, Tully S, Franceschi S. Carcinogenicity of human papillomavirus types in HIV-positive women: A meta-analysis from HPV infection to cervical cancer. Clin Infect Dis. 2017 Feb 12, http://dx.doi.org/10.1093/cid/cix135
For further information please refer to: ClinicalTrials.gov NCT01792973
Results
  • 26% of the women had at least one HPV infection, and 19% had an HR-HPV infection.
  • Low level of education, younger age and low CD4 cells count were significantly associated with the presence of an HR-HPV infection.
  • Pap smears showed that 3% of patients had high grade cervical lesions and the presence of such lesions was significantly associated with that of HR-HPV infection.
​The analysis of the follow-up in terms of incidence, persistence and clearance of HR-HPV infections and cervical lesions are ongoing. They will provide important information to policy makers in terms of screening strategies and potential benefits of HPV vaccine implementation.