Persistence of HPV in cervical smears of vaccinated WLWH support for combined molecular testing and cytology screening

Background Human papillomavirus (HPV) infection profoundly affects women living with HIV (WLWH). This infection leads to cervical cancer (CC) and increased mortality. Methods This study monitored HPV infection in WLWH in Rio de Janeiro, Brazil, before (T1) and after (T2) 4 years of vaccination. HPV genotyping and the presence of intraepithelial lesions were investigated at both time points. Results Among the 156 WLWH who received the quadrivalent HPV vaccine (4vHPV) at T1, 30 (19.2%) were initially found to have HPV DNA. After vaccination, only three (7%) of those who were HPV-negative at T1 tested positive for HPV. Most women who tested positive for HPV DNA at T1 had normal Pap smear results. However, this cohort also demonstrated a significant increase in cases of atypical squamous cells of uncertain significance and cervical intraepithelial neoplasia in PCR-negative HPV DNA samples at T2 ( p < .01). Conversely, women who initially tested negative for HPV DNA continued to exhibit normal Pap smear results in 2018 ( p < .01). Conclusions This study highlights the persistence of HPV in WLWH despite vaccination and underscores the importance of continued molecular and cytologic screening. The findings enhance our understanding of vaccine effectiveness in this population and emphasize the need for tailored preventive strategies.