Combination antiretroviral therapy reduces the detection risk of cervical human papilloma virus infection in women living with HIV

Zeier, M; Botha, Matthys H.; Engelbrecht, Susan; Machekano, Rhoderick; Jacobs, Graeme Brendon; Isaacs, Shahieda; Schalkwyk, Marije Van; Merwe, Haynes Van der; Mason, Deidre; Nachega, Jean B.

doi:10.1097/qad.0000000000000512

Cited by 28 publications

(33 citation statements)

References 31 publications

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“…Moreover, immune defects associated with HIV infection probably contribute to the HPV pathogenesis by preventing spontaneous clearance of HPV [6]. A recent study found that in WLWH every month on HAART reduced the detection risk of any cervical HPV infection by 9 % [30]. Likewise, short duration of HAART predicted HPV in the current study.…”

Section: Discussionsupporting

confidence: 55%

“…Nine candidate predictor variables were chosen a priori due to current knowledge on risk factors of HPV [6, 30, 31]; age (18–29, 30–50 and >50 years of age), race, age at sexual debut (<16 versus ≥ 16 years of age), HAART duration (years on HAART), AIDS prior to inclusion, smoking status, number of lifetime sexual partners (<5 versus ≥ 5), use of hormonal contraceptives, and CD4 count at inclusion (<200, ≥200-349 and ≥350 cells/μL).…”

Section: Methodsmentioning

confidence: 99%

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Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

et al. 2016

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BackgroundWomen living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH.MethodsWLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities.WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities.ResultsOf 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)).ConclusionsWLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2881-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

et al. 2016

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“…A previous study by Palefsky (9) evaluated whether the use of cART has an influence on the prevalence of anal HPV infection by immune recovery, finding that it lead to a limited reduction in HPV prevalence and the regression of cervical intraepithelial neoplasia. Subsequently, it was demonstrated that the risk of persistent HPV infection in HIV-infected women under long-term cART was reduced due to sustained viral suppression and increased CD4 counts (34,35). The relatively short duration of cART use in the present study did not have a significant effect on anal HPV reduction.…”

Section: Discussionmentioning

confidence: 47%

“…Regarding the prevalence of different HPV genotypes in the cervix and anus, 13 high-risk HPV genotypes (16,18,31,33,35,39,45, 51, 52, 56, 58, 59 and 68) and 11 low-risk HPV genotypes (6,11,44, 53, 54, 66, 69, 70, 71, 74 and 82) were found. Fig.…”

Section: Cervical and Anal Hpv Findingsmentioning

confidence: 99%

Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations

et al. 2017

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Abstract. Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)-and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages.

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“…Our finding is similar to reports that have shown no protective effect of ART on HPV clearance 33,34 and contrary with studies that show greater HPV clearance with the institution of ART. 35–37 …”

Section: Discussionmentioning

confidence: 99%

Rates and determinants of incidence and clearance of cervical HPV genotypes among HIV-seropositive women in Pune, India

Mane

Sahasrabuddhe

Nirmalkar

et al. 2017

Journal of Clinical Virology

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Background Several studies in recent years have documented the genotype-specific prevalence of HPV infection and wide diversity and multiplicity of HPV genotypes among HIV-seropositive women. Yet, information on changes in HPV genotype-specific incidence and clearance rates over time, and their correlation with clinical or immunologic factors among HIV-seropositive women is scarce. Objectives We conducted a prospective study to investigate the incidence and clearance rates of cervical HPV genotypes among HIV-seropositive women in India and expand the evidence base in this area of research. Study design Cervical samples were collected from n=215 HIV-seropositive women in Pune, India who underwent two screening visits separated by a median of 11-months (interquartile range: 8–18 months). HPV genotypes were determined by Roche Linear Array HPV assay. Individual genotype-specific and carcinogenicity-grouping-specific HPV incidence and clearance rates were calculated and the associations between incidence/clearance and age and HIV-related metrics were explored. Results Incidence and clearance rates for ‘any HPV’ and ‘carcinogenic HPV’ genotypes were 11.1 and 18.3, and 6.7 and 33.8, per 100 person-years, respectively. Incidence and clearance rates for HPV genotypes of alpha-9 species (HPV16, HPV31, HPV33, HPV35, HPV52 and HPV58) and alpha-7 species (HPV18, HPV39, HPV45, HPV59 and HPV68) were 5.8 and 2.04, and 32.1 and 53.5, per 100 person-years, respectively. Clearance of any HPV type was associated with increasing age of participants (odds ratio: 1.08, 95%CI: 1.004–1.17), although the association marginally lost its statistical significance when adjusted for CD4 counts and antiretroviral therapy status. Conclusions Genotype-specific clearance rates of HPV were higher than corresponding incidence rates. The suggestion of a positive associations of increasing age with HPV clearance points to the need for etiologic studies on age-related hormonal changes on clearance of cervical HPV infection.

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Combination antiretroviral therapy reduces the detection risk of cervical human papilloma virus infection in women living with HIV

Abstract: cART significantly reduced cervical HPV infection. This effect was dependent on the duration of exposure to cART and is the mechanism by which cART may improve the outcome of dysplasia in HIV-infected women.

Cited by 28 publications

References 31 publications

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations

Rates and determinants of incidence and clearance of cervical HPV genotypes among HIV-seropositive women in Pune, India

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