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Cited by 421Cervical Cancer and HPV ResearchHIV/AIDS Research and InterventionsReproductive tract infections research

HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer

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Liu, Gui, Sharma, Monisha, Tan, Nicholas, Barnabas, Ruanne V.·2018·AIDS
DOI 10.1097/qad.0000000000001765PMC PMC5854529
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Abstract

OBJECTIVE: HIV-positive women have higher human papillomavirus (HPV) prevalence and cervical cancer incidence than HIV-negative women, partly because of HIV's modifying effect on HPV pathogenesis. We synthesized the literature on the impact of HIV on HPV natural history. DESIGN: Systematic review and meta-analysis. METHODS: We searched the literature for studies evaluating HPV acquisition and persistence or precancer progression by HIV status. Data on HPV natural history by HIV status, CD4 cell counts, viral load, and antiretroviral therapy (ART) were summarized using fixed effect models. RESULTS: Overall, 38 of 1845 abstracts identified met inclusion criteria. HIV-positive women had higher HPV acquisition [relative risk (RRpooled) 2.64, 95% confidence interval (CI) 2.04-3.42] and lower HPV clearance (hazard ratiopooled 0.72, 95% CI 0.62-0.84) than HIV-negative women. HPV acquisition was higher with declining CD4 cell count and was lower in those virally suppressed on ART. HIV was associated with higher incidence of low-grade squamous intraepithelial lesions (LSIL; RRpooled 3.73, 95% CI 2.62-5.32) and high-grade squamous intraepithelial lesions (HSIL; hazard ratiopooled 1.32, 95% CI 1.10-1.58), largely because of increased HPV persistence. ART lowered progression from normal cytology to LSIL (hazard ratiopooled 0.65, 95% CI 0.52-0.82), but not HSIL. Cervical cancer incidence was associated with HIV positivity (RR 4.1, 95% CI 2.3-6.6), but not with ART. CONCLUSION: HIV-positive women have higher risk of acquiring HPV, with risk inversely associated with CD4 cell count. ART lowered HPV acquisition, increased clearance, and reduced precancer progression, likely via immune reconstitution. Although some of our results are limited by small number of studies, our study can inform screening guidelines and mathematical modeling for cervical cancer prevention.

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Authors
Liu, G., Sharma, M., Tan, N., & Barnabas, R. V.
Affiliations
University of Washington (US)
Corresponding author
Liu, Gui
ORCID
Venue
AIDS
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-03-27
Volume
32
Issue
6
Pages
795-808
ISSN
0269-9370 (ISSN-L)
DOI
10.1097/qad.0000000000001765
PMC
PMC5854529
OpenAlex
W2981365593
Cited by
421
References
1
Citations by year
2026: 56 · 2025: 66 · 2024: 56 · 2023: 68 · 2022: 68 · 2021: 45 · 2020: 37 · 2019: 17 · 2018: 8
FWCI
3.82
Type
journal article
Language
en
Open access
Locations
  • AIDS (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (U01CA199334)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
HIV, human papillomavirus, HPV acquisition, persistent HPV infection, cervical cancer, precancerous lesions, squamous intraepithelial lesions, CD4 count, antiretroviral therapy, immune reconstitution, HPV clearance, cervical cancer screening
MeSH terms
Adolescent, Adult, Carcinoma, Squamous Cell, Uterine Cervical Neoplasms, Female, Humans, Precancerous Conditions, HIV Infections, Prevalence, Risk Assessment, CD4 Lymphocyte Count, Viral Load, Papillomavirus Infections, Anti-Retroviral Agents, Young Adult

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