Association of HIV status with infection by multiple HPV types Milena Camargo 1,2, *, Luisa Del R  ıo-Ospina 1, *, Sara Cecilia Soto-De Le on 1,3, *, Ricardo S anchez 1,4 , Andrea Clemencia Pineda-Pe~ na 1 , Otto Sussmann 5 , Manuel Elkin Patarroyo 1,4 and Manuel Alfonso Patarroyo 1,6 1 Molecular Biology and Immunology Department, Fundaci on Instituto de Inmunolog  ıa de Colombia, Bogot a DC, Colombia 2 PhD Program in Biomedical and Biological Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogot a DC, Colombia 3 Universidad de Ciencias Aplicadas y Ambientales, Bogot a DC, Colombia 4 Medical School, Universidad Nacional de Colombia, Bogot a DC, Colombia 5 Asistencia Cient  ıfica de Alta Complejidad S.A.S., Bogot a DC, Colombia 6 Basic Sciences Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogot a DC, Colombia Abstract objectives To identify the clinical and demographic characteristics of HIV-positive and HIV- negative women infected by multiple HPV types. methods 1399 women participated in the study (240 HIV-positive and 1159 HIV-negative women). Samples were provided for Pap tests and for HPV detection and typing by PCR. Data were collected on HPV infection, frequency of multiple infection, and HPV type distribution. Odds ratios were reported from logistic regression models. results Compared with HIV-negative women, HIV-positive women had higher frequencies of cervical abnormality (30% vs. 20.8%), higher HPV prevalence (68.3% vs. 51.3%) and were more commonly infected with multiple HPV types (78.7% vs. 44.3%). HPV-16 was the most common type detected in the study population, with other types showing variable associations with HIV status. Positive associations were observed between infection by multiple HPV types and HIV status, cervical abnormality and having had more than three pregnancies. The odds of multiple infection by HPV types were higher in HIV-positive women who used an intrauterine device, who had a history of abortions and who had HIV viral loads >100 000 copies/ml, whilst the odds were lower in women with >500 CD4 cells/mm 3 . conclusions HIV immunosuppression favours infection by multiple high-risk HPV types, mainly in women affected by low-grade squamous intraepithelial lesions. Antiretroviral therapy had no effect on infection by multiple HPV types. Risk factors related to progressive damage to the cervix were positively associated with infection by multiple HPV types in women living with HIV. keywords human papillomavirus, human immunodeficiency virus, multiple infection, epidemiology, risk factor Introduction High-risk (HR) human papillomavirus (HPV) types are highly prevalent sexually transmitted diseases (STDs) in women living with human immunodeficiency virus (HIV) [1]. HIV favours HPV persistence and modulates the expression of the HPV E6 and E7 genes, which are responsible for oncogenic transformation [2, 3]. HPV per- sistence is favoured as a result of HIV-induced impair- ment of host immune responses, which limits the host’s ability to control infection and permits infection by multiple HPV types. Infection by multiple HR-HPV types has been observed in a significant proportion of HIV- positive women [4]. Persistent infection by HR-HPV constitutes a risk fac- tor directly associated with cervical cancer (CC) [5, 6]. HIV-associated immunosuppression is a key factor con- tributing to increased morbidity and mortality of this neoplasia [7]. The risk of developing lesions arising from HPV infection is significantly increased in HIV-positive women, with CC incidence approximately 20-fold higher than in HIV-negative women [8]. The clinical importance of infection by multiple HR- HPV types remains controversial. An intraepithelial lesion *These authors contributed equally to this work. © 2018 John Wiley & Sons Ltd 1259 Tropical Medicine and International Health doi:10.1111/tmi.13142 volume 23 no 11 pp 1259–1268 november 2018