Prevalence of human papillomavirus genotypes in women from three clinical settings.

Prevalence of 27 human papillomavirus (HPV) genotypes was assessed in 1,331 women in three clinical settings: Family planning clinic (low-risk HIV-, n = 202, 21.3% HPV+), colposcopy clinic (high-risk HIV-, n = 854, 34.3% HPV+), and HIV outpatient clinic (HIV+, n = 275, 48.7% HPV+). Compared to women from both family planning and colposcopy clinics, HIV+ women revealed significantly higher prevalence of infection with oncogenic, non-oncogenic, and multiple HPV types. HPV types 52 and 51 were most prevalent in the low-risk HIV- women, whereas in the high-risk HIV- women, HPV types 16, 52, 58, and 35 were most prevalent. Interestingly, in the HIV+ women, less characterized types 83, 53, and 54 were most prevalent. The distinct profiles of genotype prevalence persisted after stratification by Pap smear status. After adjustment for concurrent infections with other types, HPV type 51 in the low-risk HIV- women, and types 16, 35, 39, 45, 52, and 58 in the high-risk HIV- women were significantly associated with cytologic abnormalities (exact P < 0.05). In HIV+ women across CD4 cell count strata, HPV types 42, 16, and 82 revealed significant decreasing trends with increasing CD4 counts (exact P for trend < 0.05). These data suggest distinct genotypic prevalence profiles in women at diverse risk for cervical cancer. The association of several genotypes with cytologic abnormalities underscores the need for vaccines targeting a wide range of HPV types.

Distribution of human papillomavirus type 16 variants in human immunodeficiency virus type 1-positive and -negative women.

The prevalence of human papillomavirus type 16 E6 variant lineages was characterized in a cross-sectional study of 24 human immunodeficiency virus type 1 (HIV)-positive and 33 HIV-negative women in New Orleans. The European prototype was the predominant variant in the HIV-negative women (39.4 %), while in the HIV-positive women the European 350G variant was predominant (29.1 %). In exact logistic regression models, HIV-positive women were significantly more likely to harbour any variant with a nucleotide G-350 mutation compared with HIV-negative women [58.3 % vs 21.1 %; adjusted odds ratio (AOR)=6.28, 95 % confidence interval (CI)=1.19-46.54]. Models also revealed a trend towards increased prevalence of Asian-American lineage in HIV-positive women compared with HIV-negative women (25.0 % vs 6.0 %; AOR=6.35, 95 % CI=0.77-84.97). No association was observed between any variant and cytology or CD4 cell counts or HIV-1 viral loads. These observations reflect a difference in the distribution of HPV-16 variants among HIV-positive and -negative women, indicating that HIV-positive status may lead to increased prevalence of a subset of variants.

Combined intraperitoneal and intravenous chemotherapy for women with optimally debulked ovarian cancer: results from an intergroup phase II trial.

PURPOSE: The median survival time for women with optimally debulked adenocarcinoma of the ovary treated with intravenous (IV) chemotherapy is 41 to 52 months, and the 2-year survival rate is 65% to 70%. Recent studies evaluating intraperitoneal (IP) chemotherapy have reported a median survival time of 49 to 63 months and 2-year survival rates of 70% to 80%. This phase II trial was undertaken to evaluate the feasibility of and 2-year survival rate achieved by the combination of IP paclitaxel, IP cisplatin, and IV paclitaxel in women with optimally debulked, stage III ovarian cancer. PATIENTS AND METHODS: Treatment consisted of paclitaxel 135 mg/m(2) IV over 24 hours on days 1 to 2, cisplatin 100 mg/m(2) IP on day 2, and paclitaxel 60 mg/m(2) IP on day 8 administered every 21 days for six cycles. RESULTS: In 68 assessable women with optimal stage III ovarian cancer, the 2-year survival rate was 91%, and the median survival time was 51 months. The 2-year disease-free survival rate was 66%, and median disease-free survival time was 33 months. Ninety-six percent of all patients experienced at least one grade 3 to 4 adverse event during therapy, with the most common events being neutropenia (79%), nausea (50%), vomiting (34%), and fatigue/malaise/lethargy (24%). Seventy-one percent of patients completed all six cycles of IV/IP therapy as planned. CONCLUSION: Combined IV and IP chemotherapy with cisplatin and paclitaxel is associated with a very promising 2-year survival rate in women with optimally debulked ovarian cancer. The ultimate impact of this approach on overall survival requires further evaluation in a randomized trial setting.