HIV-positive women have higher risk of HPV infection, precancerous lesions, and cervical cancer: A systematic review and meta-analysis

OBJECTIVES: HIV-positive women have higher human papillomavirus (HPV) prevalence and cervical cancer (CC) incidence than HIV-negative women, partly due to 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 ratio [HRpooled]=0.72, 95% CI 0.62-0.84) than HIV-negative women. HPV acquisition was higher with declining CD4 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) (HRpooled=1.32, 95% CI 1.10-1.58), largely due to increased HPV persistence. ART lowered progression from normal cytology to LSIL (HRpooled=0.65, 95% CI 0.52-0.82), but not HSIL. CC incidence was associated with HIV positivity (RR=4.1, 95% CI 2.3-6.6), but not with ART. CONCLUSIONS: HIV-positive women have higher risk of acquiring HPV, with risk inversely associated with CD4 count. ART lowered HPV acquisition, increased clearance, and reduced precancer progression, likely via immune reconstitution. While some of our results are limited by small number of studies, our study can inform screening guidelines and mathematical modeling for CC prevention

• Population(s)
  • Women
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Other
• Co-morbidities
  • Cancer