HIV Status Increases Risk of HPV Progressing to Precancerous Lesions

The human papillomavirus (HPV) is the most common sexually transmitted infection, with nearly all individuals who are sexually active contracting the infection at some point in their lives, according to the CDC.

HPV will frequently disappear on its own without causing health problems. But when the virus persists, it can lead to the development of precancerous lesions and cervical cancer.

Prior studies show a link between HIV and HPV that increases the risk of HPV-associated morbidity and cancer mortality among HIV-positive women.

In a study published in Cancer Epidemiology, Biomarkers & Prevention, the investigators sought to examine how the natural history of cervical HPV infection differs by HIV status.

The investigators analyzed data from 6 studies conducted in Senegal, West Africa, between 1994 and 2010. They followed 1320 women for an average of 2 years and conducted cytology—–with a subsample of histology––and HPV DNA testing at approximately 4-month intervals, yielding data from more than 7900 clinic visits.

During each clinic visit, the women were characterized as normal, HPV-positive, or HPV-positive with high-grade squamous intraepithelial lesions (HSIL). For women with HIV, exploratory univariate analyses were conducted examining the impact of HPV type, infection with multiple HPV types, HIV type, CD4+ count, and age.

The results of the study showed that HIV-positive women had higher rates of progression and lower rates of regression compared with HIV-negative women.

Women with HIV were also more likely to have HPV infection progress to pre-cancer. HIV-positive women had a 2.55 times higher rate of progression from HPV to HSIL than HIV-negative women. Furthermore, HPV-16/18 infection and CD4+ count <200/mm3 were associated with adverse transitions.

Reasons for this occurrence is because as HIV takes hold of the body’s immune system, HPV goes unchecked, allowing it to replicate rapidly and develop abnormal lesions that can progress to cancer, said study author Hilary K. Whitham, PhD, MPH.

The findings suggest that in the limited-resource setting of sub-Saharan Africa, the high-risk population of women with HIV may be an ideal target.

“In areas where cervical cancer screening is not widely available and HIV prevalence is high, these findings highlight that targeted screening of the high-risk HIV-positive population may provide an important step in cervical cancer prevention,” Dr Whitham said. “These results also highlight that HPV vaccination of young women prior to HIV infection is an important preventive measure.”

A limitation to the study was that a large proportion of the data predated the widespread use of antiretroviral therapy (ART), which limited the capacity to analyze the effects of those treatments on HPV progression, according to the authors. Additionally, HIV-positive women are now living longer due to ART and may face an increased risk of cervical cancer because they have more time to acquire HPV and for precancerous lesions to progress to cervical cancer. Dr Whitham noted that this highlights the need for cervical cancer prevention strategies in areas where HIV is endemic.

The authors suspect that their findings would be similar in women from other countries, but more research needs to be done to confirm the findings and to account for behavioral differences between populations.