Modifiable and non-modifiable factors related to HPV infection and cervical abnormalities in women at high risk: a cross-sectional analysis from the Valhidate Study

Abstract: Migrant women, and women infected with HIV, are at enhanced risk of cervical HPV infection and HPV-related cancers. We investigated factors that can reduce these risks through public health preventive and screening interventions. We compared prevalence and risk factors for cervical HPV infection/lesions in women with HIV-infection (HIW) and migrant women (RMW) with a control group of resident women (SPW) who were enrolled in the study for the eVALuation and monitoring of HPV Infections and relATEd cervical diseases in high-risk women (VALHIDATE). Among 3093 evaluable women, age-standardized HPV prevalence was 36.3% (95%CI: 28.1–44.4) in HIW, 21.6% (95%CI: 15.7–27.5) in RMW, and 14.3% (95%CI: 12.5–16.1) in SPW. Adjusted prevalence of HPV infection was 2.07 times higher among HIW (95%CI: 1.75–2.45), and 1.45 times higher among RMW (95%CI: 1.17–1.80) than in SPW. Prevalence-ratios of SIL and HG-SIL were 2.67 (95%CI: 2.06–3.45) and 2.82 (95%CI: 1.28–6.20), respectively, in HIW compared to controls. A multivariate log-binomial regression model showed modifiable risk factors associated with HPV infection/lesion to have different patterns among groups. Specific public-health intervention, including health and sexual-health education, safe-sex procedures, and improvements to screening programmes, could favorably affect these highly vulnerable women.