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Concomitant Infection of HIV and HPV: What Are the Consequences?

  • Management of HPV and Associated Cervical Lesions (L Denny, Section Editor)
  • Published:
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Abstract

Data support the impact of antiretroviral therapy (ART) on the burden of cervical HPV and related lesions. ART is effective at reducing the prevalence and incidence of high-risk (HR)-HPV infection but only over longer duration, and among patients with effective ART (i.e. with high adherence, HIV viral suppression and increasing CD4+ T lymphocyte counts). ART has a protective effect against squamous intraepithelial lesion (SIL) incidence and progression and induces regression with the greatest likelihood among adherent users. ART initiated at high CD4+ is effective at preventing HR-HPV infection and SIL progression. If ART is started at a low nadir CD4+, women have increased risk of SIL progression and screening will be important at frequent intervals.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Clifford GM, Polesel J, Rickenbach M, Dal Maso L, Keiser O, Kofler A, et al. Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy. J Natl Cancer Inst. 2005;97(6):425–32.

    Article  PubMed  Google Scholar 

  2. Cobucci RN, Lima PH, de Souza PC, Costa VV, Cornetta Mda C, Fernandes JV, et al. Assessing the impact of HAART on the incidence of defining and non-defining AIDS cancers among patients with HIV/AIDS: a systematic review. J Infect Public Health. 2015;8(1):1–10.

    Article  PubMed  Google Scholar 

  3. WHO. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization; 2013.

  4. Bower M, Palfreeman A, Alfa-Wali M, Bunker C, Burns F, Churchill D, et al. British HIV Association guidelines for HIV-associated malignancies 2014. HIV Med. 2014;15:1–92.

    Google Scholar 

  5. Belhadj H, Rasanathan JJ, Denny L, Broutet N. Sexual and reproductive health and HIV services: integrating HIV/AIDS and cervical cancer prevention and control. Int J Gynaecol Obstet. 2013;121 Suppl 1:S29–34.

    Article  PubMed  Google Scholar 

  6. Woodman CB, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7(1):11–22.

    Article  CAS  PubMed  Google Scholar 

  7. Strickler HD, Burk RD, Fazzari M, Anastos K, Minkoff H, Massad LS, et al. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2005;97(8):577–86.

    Article  PubMed  Google Scholar 

  8. McDonald AC, Tergas AI, Kuhn L, Denny L, Wright Jr TC. Distribution of human papillomavirus genotypes among HIV-positive and HIV-negative women in Cape Town. S Africa Front Oncol. 2014;4:48.

    Google Scholar 

  9. Blitz S, Baxter J, Raboud J, Walmsley S, Rachlis A, Smaill F, et al. Evaluation of HIV and highly active antiretroviral therapy on the natural history of human papillomavirus infection and cervical cytopathologic findings in HIV-positive and high-risk HIV-negative women. J Infect Dis. 2013;208(3):454–62.

    Article  CAS  PubMed  Google Scholar 

  10. De Vuyst H, Mugo NR, Chung MH, McKenzie KP, Nyongesa-Malava E, Tenet V, et al. Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya. Br J Cancer. 2012;107(9):1624–30. Prolonged ART duration is important in reducing prevalence of HR-HPV. Low CD4 is an important predictor of CIN2+ prevalence in ART-naïve, but there is no association among ART users—suggesting importance of nadir CD4.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Bosch FX, Broker TR, Forman D, Moscicki AB, Gillison ML, Doorbar J, et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine. 2013;31 Suppl 7:H1–31.

    Article  PubMed  Google Scholar 

  12. Ahdieh L, Klein RS, Burk R, Cu-Uvin S, Schuman P, Duerr A, et al. Prevalence, incidence, and type-specific persistence of human papillomavirus in human immunodeficiency virus (HIV)-positive and HIV-negative women. J Infect Dis. 2001;184(6):682–90.

    Article  CAS  PubMed  Google Scholar 

  13. Minkoff H, Feldman J, DeHovitz J, Landesman S, Burk R. A longitudinal study of human papillomavirus carriage in human immunodeficiency virus-infected and human immunodeficiency virus-uninfected women. Am J Obstet Gynecol. 1998;178(5):982–6.

    Article  CAS  PubMed  Google Scholar 

  14. Moscicki AB, Ellenberg JH, Farhat S, Xu J. Persistence of human papillomavirus infection in HIV-infected and -uninfected adolescent girls: risk factors and differences, by phylogenetic type. J Infect Dis. 2004;190(1):37–45.

    Article  PubMed  Google Scholar 

  15. Hawes SE, Critchlow CW, Faye Niang MA, Diouf MB, Diop A, Toure P, et al. Increased risk of high-grade cervical squamous intraepithelial lesions and invasive cervical cancer among African women with human immunodeficiency virus type 1 and 2 infections. J Infect Dis. 2003;188(4):555–63.

    Article  PubMed  Google Scholar 

  16. La Ruche G, You B, Mensah-Ado I, Bergeron C, Montcho C, Ramon R, et al. Human papillomavirus and human immunodeficiency virus infections: relation with cervical dysplasia-neoplasia in African women. Int J Cancer. 1998;76(4):480–6.

    Article  PubMed  Google Scholar 

  17. Denny LA, Franceschi S, de Sanjose S, Heard I, Moscicki AB, Palefsky J. Human papillomavirus, human immunodeficiency virus and immunosuppression. Vaccine. 2012;30 Suppl 5:F168–74.

    Article  CAS  PubMed  Google Scholar 

  18. Ezechi OC, Ostergren PO, Nwaokorie FO, Ujah IA, Odberg PK. The burden, distribution and risk factors for cervical oncogenic human papilloma virus infection in HIV positive Nigerian women. Virol J. 2014;11:5.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Fife KH, Wu JW, Squires KE, Watts DH, Andersen JW, Brown DR. Prevalence and persistence of cervical human papillomavirus infection in HIV-positive women initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2009;51(3):274–82.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Konopnicki D, Manigart Y, Gilles C, Barlow P, de Marchin J, Feoli F, et al. Sustained viral suppression and higher CD4+ T-cell count reduces the risk of persistent cervical high-risk human papillomavirus infection in HIV-positive women. J Infect Dis. 2013;207(11):1723–9. Sustained HIV plasma viral suppression and high nadir CD4+ decrease risk of HR-HPV among predominantly African women in Belgium.

    Article  CAS  PubMed  Google Scholar 

  21. Mane A, Nirmalkar A, Risbud AR, Vermund SH, Mehendale SM, Sahasrabuddhe VV. HPV genotype distribution in cervical intraepithelial neoplasia among HIV-infected women in Pune, India. PLoS ONE. 2012;7(6), e38731.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Grinsztejn B, Veloso VG, Levi JE, Velasque L, Luz PM, Friedman RK, et al. Factors associated with increased prevalence of human papillomavirus infection in a cohort of HIV-infected Brazilian women. Int J Infect Dis. 2009;13(1):72–80.

    Article  PubMed  Google Scholar 

  23. Zhang HY, Tiggelaar SM, Sahasrabuddhe VV, Smith JS, Jiang CQ, Mei RB, et al. HPV prevalence and cervical intraepithelial neoplasia among HIV-infected women in Yunnan Province, China: a pilot study. Asian Pac J Cancer Prev Apjcp. 2012;13(1):91–6.

    Article  PubMed  Google Scholar 

  24. Minkoff H, Zhong Y, Burk RD, Palefsky JM, Xue X, Watts DH, et al. Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-positive women. J Infect Dis. 2010;201(5):681–90.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Konopnicki D, Manigart Y, Gilles C, Barlow P, de Marchin J, Feoli F, et al. High-risk human papillomavirus infection in HIV-positive African women living in Europe. J Int AIDS Soc. 2013;16:18023.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Paramsothy P, Jamieson DJ, Heilig CM, Schuman PC, Klein RS, Shah KV, et al. The effect of highly active antiretroviral therapy on human papillomavirus clearance and cervical cytology. Obstet Gynecol. 2009;113(1):26–31.

    Article  PubMed  Google Scholar 

  27. Lillo FB, Ferrari D, Veglia F, Origoni M, Grasso MA, Lodini S, et al. Human papillomavirus infection and associated cervical disease in human immunodeficiency virus-infected women: effect of highly active antiretroviral therapy. J Infect Dis. 2001;184(5):547–51.

    Article  CAS  PubMed  Google Scholar 

  28. Clifford GM, Goncalves MA, Franceschi S, Hpv, Group HIVS. Human papillomavirus types among women infected with HIV: a meta-analysis. AIDS. 2006;20(18):2337–44.

    Article  PubMed  Google Scholar 

  29. MMWR. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41(Rr-17):1–19.

    Google Scholar 

  30. Hawes SE, Critchlow CW, Sow PS, Toure P, N’Doye I, Diop A, et al. Incident high-grade squamous intraepithelial lesions in Senegalese women with and without human immunodeficiency virus type 1 (HIV-1) and HIV-2. J Natl Cancer Inst. 2006;98(2):100–9.

    Article  PubMed  Google Scholar 

  31. Firnhaber C, Westreich D, Schulze D, Williams S, Siminya M, Michelow P, et al. Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa. J Int AIDS Soc. 2012;15(2):17382. Decreased risk in SIL incidence or cytological progression among ART users compared to ART-naïve in South Africa is shown—only among those with low CD4+. Those with high CD4+ have similar risk as ART-naïve.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Huchko MJ, Leslie H, Sneden J, Maloba M, Abdulrahim N, Bukusi EA, et al. Risk factors for cervical precancer detection among previously unscreened HIV-infected women in Western Kenya. Int J Cancer. 2014;134(3):740–5. Low nadir CD4+ is an important predictor of prevalent cervical lesions.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. de Andrade AC, Luz PM, Velasque L, Veloso VG, Moreira RI, Russomano F, et al. Factors associated with colposcopy-histopathology confirmed cervical intraepithelial neoplasia among HIV-infected women from Rio De Janeiro, Brazil. PLoS ONE. 2011;6(3), e18297. Low nadir CD4+ T lymphocyte count is an important predictor of prevalent cervical lesions.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Sahasrabuddhe VV, Bhosale RA, Joshi SN, Kavatkar AN, Nagwanshi CA, Kelkar RS, et al. Prevalence and predictors of colposcopic-histopathologically confirmed cervical intraepithelial neoplasia in HIV-infected women in India. PLoS ONE. 2010;5(1), e8634.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ezechi OC, Pettersson KO, Okolo CA, Ujah IA, Ostergren PO. The association between HIV infection, antiretroviral therapy and cervical squamous intraepithelial lesions in South Western Nigerian women. PLoS ONE. 2014;9(5), e97150.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Bateman AC, Katundu K, Mwanahamuntu MH, Kapambwe S, Sahasrabuddhe VV, Hicks ML, et al. The burden of cervical pre-cancer and cancer in HIV positive women in Zambia: a modeling study. BMC Cancer. 2015;15:541.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Adler DH, Kakinami L, Modisenyane T, Tshabangu N, Mohapi L, De Bruyn G, et al. Increased regression and decreased incidence of human papillomavirus-related cervical lesions among HIV-infected women on HAART. AIDS. 2012;26(13):1645–52.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Soncini E, Zoncada A, Condemi V, Antoni AD, Bocchialini E, Soregotti P. Reduction of the risk of cervical intraepithelial neoplasia in HIV-infected women treated with highly active antiretroviral therapy. Acta Bio-Med Ateneo Parmense. 2007;78(1):36–40.

    Google Scholar 

  39. Omar T, Schwartz S, Hanrahan C, Modisenyane T, Tshabangu N, Golub JE, et al. Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort. AIDS. 2011;25(1):87–94.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Zeier MD, Botha MH, van der Merwe FH, Eshun-Wilson I, van Schalkwyk M, la Grange M, et al. Progression and persistence of low-grade cervical squamous intraepithelial lesions in women living with human immunodeficiency virus. J Low Genit Tract Dis. 2012;16(3):243–50.

    Article  PubMed  Google Scholar 

  41. Heard I, Tassie JM, Kazatchkine MD, Orth G. Highly active antiretroviral therapy enhances regression of cervical intraepithelial neoplasia in HIV-seropositive women. AIDS. 2002;16(13):1799–802.

    Article  CAS  PubMed  Google Scholar 

  42. Sirera G, Videla S, Lopez-Blazquez R, Llatjos M, Tarrats A, Castella E, et al. Evolution of cervical cytologic changes among HIV-infected women with normal cytology in the HAART era. AIDS Res Hum Retrovir. 2007;23(8):965–71.

    Article  PubMed  Google Scholar 

  43. Minkoff H, Ahdieh L, Massad LS, Anastos K, Watts DH, Melnick S, et al. The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women. AIDS. 2001;15(16):2157–64.

    Article  CAS  PubMed  Google Scholar 

  44. Schuman P, Ohmit SE, Klein RS, Duerr A, Cu-Uvin S, Jamieson DJ, et al. Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis. 2003;188(1):128–36.

    Article  PubMed  Google Scholar 

  45. Firnhaber C, Van Le H, Pettifor A, Schulze D, Michelow P, Sanne IM, et al. Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa. Cancer Causes Control. 2010;21(3):433–43.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Kim SC, Messing S, Shah K, Luque AE. Effect of highly active antiretroviral therapy (HAART) and menopause on risk of progression of cervical dysplasia in human immune-deficiency virus- (HIV-) infected women. Infec Dis Obstet Gynecol. 2013;2013:784718.

    Article  Google Scholar 

  47. Sirera G, Videla S, Lopez-Blazquez R, Llatjos M, Tarrats A, Castella E, et al. Highly active antiretroviral therapy and incidence of cervical squamous intraepithelial lesions among HIV-infected women with normal cytology and CD4 counts above 350 cells/mm3. J Antimicrob Chemother. 2008;61(1):191–4.

    Article  CAS  PubMed  Google Scholar 

  48. Wright ST, Carr A, Woolley I, Giles M, Hoy J, Cooper DA, et al. CD4 cell responses to combination antiretroviral therapy in patients starting therapy at high CD4 cell counts. J Acquir Immune Defic Syndr. 2011;58(1):72–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Palefsky J. Biology of HPV in HIV infection. Adv Dent Res. 2006;19(1):99–105.

    Article  CAS  PubMed  Google Scholar 

  50. Corbeau P, Reynes J. Immune reconstitution under antiretroviral therapy: the new challenge in HIV-1 infection. Blood. 2011;117(21):5582–90.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Helen Kelly declares no conflict of interest.

Philippe Mayaud declares research support (test donation) from Qiagen and research funding from GlaxoSmithKline.

Silvia de Sanjose declares research grants from GSK, from Merck and from Qiagen.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Grants

This work was supported by public grants from the Instituto de Salud Carlos III CIBERESP, from the Agència de Gestió d’Ajuts Universitaris i de Recerca (2014 SGR 756) and from the UK Medical Research Council (MRC) PHINDS scheme (PH01/14-39).

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Authors and Affiliations

  1. London School of Hygiene and Tropical Medicine, London, UK

    Helen Kelly & Philippe Mayaud

  2. Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, Av. Gran Via de l’Hospitalet 199-203, 08908, Barcelona, Spain

    Silvia de Sanjose

  3. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Silvia de Sanjose

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  1. Helen Kelly
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  2. Philippe Mayaud
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  3. Silvia de Sanjose
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Correspondence to Silvia de Sanjose.

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This article is part of the Topical Collection on Management of HPV and Associated Cervical Lesions

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Kelly, H., Mayaud, P. & de Sanjose, S. Concomitant Infection of HIV and HPV: What Are the Consequences?. Curr Obstet Gynecol Rep 4, 213–219 (2015). https://doi.org/10.1007/s13669-015-0132-0

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