Background:
Women living with HIV (WLWH) experience a higher burden of human papillomavirus (HPV) infection compared with the general population. Although immune dysregulation has been demonstrated in HIV-exposed, uninfected (HEU) children, their risk of HPV infection remains unclear. This study assessed the prevalence, genotype distribution, and clinical manifestations of HPV infection among pre-pubertal HEU children and their HIV-positive mothers in Poland.

Material and methods:
Thirty HEU children (median age, 17.7 months) and 28 WLWH were examined, along with 24 HIV-unexposed controls. Genital swabs were tested for 35 HPV genotypes by PCR, and HPV 6/11/16/18 antibodies were assessed by ELISA. Mothers also underwent gynecological examination and cervical cytology.

Results:
HPV DNA was detected in 12/ 28 mothers (43%), including 11 (39%) with high-risk HPV types and 21% with multiple infections (2-7 genotypes), most frequently HPV 16, 31, 52, and 83. Cytological abnormalities, such as inflammatory changes, LSIL, ASC-US, and ASC-H, occurred in 17%, 25%, 17%, and 8% of HPV-positive women, respectively. HPV DNA was found in 3/30 (10%) of HEU children and none among controls (p = 0.24), while HR-HPV accounted for 100% of HEU children infections. Nonavalent vaccine-covered genotypes were revealed in 43% of HPV infections in mothers and 75% in children. All serologic tests were negative.

Conclusions:
Women living with HIV showed a high prevalence of HPV, with frequent multiple infections and predominance of high-risk genotypes. HPV DNA was detected in 10% of HIV-exposed, uninfected children. These findings underscore the need for larger longitudinal studies to better define HPV epidemiology in HEU children, and to inform preventive strategies.