Determinants of Newly Detected Human Papillomavirus Infection in HIV-Infected and HIV-Uninfected Injection Drug Using Women

Background: We sought to identify factors associated with newly detected human papillomavirus (HPV) infection in a high-risk cohort of injection drug using women in Baltimore, MD. Methods: We studied 146 HIV-infected and 73 HIV-uninfected female participants in a 5-year prospective HIV natural history study. We examined the association of sexual and nonsexual risk factors and newly detected type-specific HPV infection as determined by consensus PCR between consecutive visits. Results: Newly detected HPV was more common among HIV-infected versus HIV-uninfected women (30% and 6%, respectively: P < 0.01). Among the entire cohort. recent crack use (OR, 1.7: 95% CI, 1.1-2.6) and HIV infection/CD4 cell count were independent predictors for new HPV detection (HIV-uninfected as reference. OR, 4.6; 95% Cl, 2.3-8.9, OR, 5.4; 95% CI. 2.8-10.3. and OR, 10.9; 95% CI, 5.5-21.7 for HIV-infected CD4, > 500, 200-500, and < 200, respectively). Among HIV-uninfected women. recent marijuana use was an independent predictor of newly detected HPV infection (OR. 3.5; 95% CI, 13-9.5). Conclusions: Newly detected HPV clearly increased with greater immunosuppression in HIV-infected injection drug users. Larger studies of HIV-uninfected and infected high-risk individuals are needed to clarify the independent associations of crack and marijuana use with new (or reactivated) HPV infection.