All ETDs from UAB

Advisory Committee Chair

Nalini Sathiakumar

Advisory Committee Members

Christopher Coffey

Craig J Hoesley

Gerald McGwin Jr

Sten H Vermund

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Persistent infection with certain “high-risk” types of human papillomavirus (HPV) infection is central to the development of cervical cancer. Human immunodeficiency virus (HIV)-infected women are at a higher risk of HPV infection, high grade cervical intraepithelial lesions, and cervical cancer. This study examined type-specific distribution of prevalent and incident HPV infections, clearance rates, and associated factors using novel molecular assays for HPV detection and genotyping in a cohort of 280 HIVinfected women in Alabama. First, we described the cohort’s sociodemographic characteristics and behavioral risk profile for HIV and other sexually transmitted infections, and assessed the factors associated with HIV-1 viral control at the baseline visit. HIV-infected women in the study were likely to be poor, African American, and with children. African American women were more likely than Caucasian women to have uncontrolled HIV-1 load (≥10,000 RNA copies/mL) at their first clinic visit. Secondly, we assessed type-specific distribution and associated factors for prevalent and incident HPV infections. HPV infection in the cohort was high, with a baseline prevalence of 67% and cumulative incidence of 83% during 2.6 years of median follow-up time. In total, 44 genotypes were detected, including 10 novel HPV types. HPV-52, a high-risk type, had the highest incidence rate of any HPV type in the entire cohort. HPV-16 and -18 were less common than other high-risk HPV types. Severe immunosuppression (CD4+ T-cell count<200/μL) was the iv most significant risk factor for prevalent infection. High-risk type and bacterial vaginosis were significantly associated with incident HPV infection. Thirdly, we evaluated typespecific clearance rates and examined the factors associated with time-to-clearance of HPV infections. HPV-18 was found to have the longest median duration of infection in this cohort. Longer time to HPV clearance was associated with high-risk HPV type, African American ethnicity, current smoking and severe immunosuppression. The results of this study of type-specific HPV distribution and clearance rates have implications for the development of new prophylactic and therapeutic vaccines, HPV DNA based cervical cancer screening tests, and mitigation of factors associated with HPV persistence for cervical cancer prevention in a region and population with high HIV and cervical cancer rates.

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