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IDSA 2007: San Diego, California; October 4-7, 2007

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The Body Covers: The 45th Annual Meeting of the Infectious Diseases Society of America
In HIV-Infected Women, Prevalence, Diversity, Persistence and Detection of New HPV Infection Is Greater in the Anus Than in the Cervix
An Interview With Erna Kojic, M.D.

October 6, 2007

Erna Kojic, M.D.
Listen (2.4MB, 6 min.)

Welcome. This is Bonnie Goldman, Editorial Director of The Body PRO. I'm in San Diego at IDSA 2007, one of the year's HIV conferences. Right now, I'm in the poster session where researchers are standing in front of their posters. There's nothing like hearing the results of research directly from those who actually conducted the research. In this interview, the researchers will introduce themselves and then summarize their study. After their summary, I'll ask a few questions.

My name is Erna Milu Kojic. I am with Brown University, the Miriam Hospital. I'm involved with the SUN study, which is the Study to Understand the Natural History of HIV and AIDS in the era of HAART [highly active antiretroviral therapy]. It's a study that's been going on for two-and-a-half years. It's an observational cohort with 682 participants, both men and women, with the aim of collecting a lot of data, both through regular, clinical care, and then additional testing to answer some particular questions related to the objectives, which are to monitor the long-term complications of HIV and AIDS in this era of therapy.

My area of interest and research is with HPV [human papillomavirus] in women -- HPV and HIV coinfection in women -- with particular emphasis on the burden of HPV disease in women, both cervical and anal, and to compare the two.

Here, I've presented results from 89 women, from baseline, in 12 months, both cervical and anal HPV data.1

On conclusion, we have a high burden of prevalence, diversity and persistence in the anal area, compared with the cervical area. That's the fact. We have a higher burden of disease in the anal area, and we still don't know whether that's going to translate into clinically significant HPV-related diseases or not. That's something that I plan on following up. It will be interesting to see if it's going to translate into more cytological abnormalities, just like HPV causes cytological abnormalities in the cervix, or not.

Do we not know whether HPV in the anal area will translate into cytological abnormalities in HIV-infected women because they haven't been infected with HIV for that many years, so we haven't followed them over 15 to 20 years?

Correct. We can find the virus, but the disease that the virus causes can take so many years to develop that it may be that we haven't reached that point yet.

In your presentation you mentioned that the women had, they said, a low number of incidents of anal receptive sex. But the HPV that was found was not only related to the cervix.

Correct. Well, there's both cervical and anal HPV. What's interesting is that this data suggest that you do not necessarily need anal receptive sex to acquire HPV infection. I think it's very transmissible, and it's quite diverse -- both cervical and anal [HPV].

I know there was a study last year that said that HPV migrates.

We don't know that yet, and it will be something that will be interesting to follow in the near future.

What should health care practitioners be doing in terms of HIV-infected female patients? Should they be doing anal Pap smears at this point?

I don't think we know enough at this point to give any such recommendation.

Because it is recommended for gay men.

It is recommended for high-risk, HIV-infected ... correct, for men. I think the question is, now that we know that it's not necessarily related to anal sex, how are we going to identify a high risk? In this particular cohort, the prevalence is just so high, we couldn't find any risk, because everybody had it. So it was difficult to identify any risk factors.

I think it will be very interesting. I think this study will be crucial in giving us more information. It will be crucial down the line to follow the cytological abnormalities. To follow cancer rates, to see what's going to happen, what is the meaning of this high anal HPV. Is it going to translate into us needing some more, or different, screening guidelines? I think that's what this is indicating.

Your results also match those from the WIHS [Women's Interagency HIV Study] cohort.2

Yes, the WIHS cohort. Correct. Except that they mostly focused on the cervical area. This is unique, in the sense that we have an ability to compare both cervix and anus, and also saw both Pap smears and HPV information.

Going forward, what are your plans? Are you doing additional studies on this cohort?

Yes. We're going to continue to follow this cohort. Obviously, it's an observational cohort. So we presented some data on abnormal cytology in both areas at the last CROI [Conference on Retroviruses and Opportunistic Infections] meeting, and the plan is to continue to follow that and hopefully get some data on both baseline and 12-month cytological abnormalities.

Great. Thanks very much.


  1. Kojic EM, Cu-Uvin S, Conley L, et al. Human papillomavirus (HPV) infection of the anus is more diverse and persistent than cervical HPV infection among HIV-infected women in the SUN study. In: Program and abstracts of the 45th Annual Meeting of the Infectious Diseases Society of America; October 4-7, 2007; San Diego, Calif. Abstract 1135.
  2. Strickler HD, Burk RD, Fazzari M, et al. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. April 20, 2005;97(8):577-586.

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