Incident genital HPV infections and potential impact of HPV vaccines in adult women living with HIV/AIDS

Abstract

This study aims to describe and characterize incident HR-HPV infections and associated diseases in HIV-infected women. 805 HIV-infected women enrolled in the VALHIDATE Study were screened and followed-up for HPV by co-testing. Social, behavioral and health data were collected. HPV-DNA positive samples were typed using a commercial kit or RFLP analysis. Conventional Pap-smears were evaluated using the 2001 Bethesda System. The participants with abnormal cytological results were referred for colposcopy. 565 HIV-infected women (median age: 43 years) were analysed, 40.9% had >5 lifetime sexual partners, 77.2% contracted HIV through sexual intercourse, 93% were receiving antiretroviral treatment and 77.3% had undetectable HIV-RNA. The women underwent 1254 follow-ups (median follow-up: 33 months) for 1430.6 PersonYear-Follow-Up. 37.4% of baseline HPV-negative women acquired incident HPV-infections, 69.6% of which were HR-HPVs. HPV-53 was the most common HPV type detected (9.3%). 18.2% of women showed incident or progressive cytological abnormalities (7.8% ASC-US, 9.7% LSIL and 0.6% HSIL) and colposcopy revealed CIN2 (N = 2), CIN1 (N = 2) and VIN3 (N = 1). The preventable fraction of incident infections was 11.3%, 16.7%, and 35.2% for the 2v-4v-9v-HPV vaccines respectively (χ2 p < 0.0001). The overall burden of incident lesions attributable to the vaccine types were 9.1% for 2v-, 14.5% for 4v- and 30.9% for 9v-vaccine. High HPV incidence rates and high percentages of multiple HR-HPV infections were observed in a cohort of HIV-infected women receiving effective antiretroviral treatment. Primary prevention strategies based on the new 9v-HPV vaccine may help to prevent incident infections and disease progression in this cohort of women.

Screening and prevention of HPV‐related anogenital cancers in women living with HIV in Europe: Results from a systematic review

“…Eight prospective studies [19][20][21][22][23][24][25][26] performed sequential screening of cervical HPV DNA with a mean followup of 3 years (range 6-33 months) and reported hrHPV DNA was positive in 287/1657 (17.3%) of women who underwent follow-up (pooled prevalence was 17.5%, 11-26.9%, I 2 = 93.3) (Table 5).…”

Anal and cervical human papillomavirus genotypes in women co-infected with human immunodeficiency virus: A systematic review

“…21 Vaccination is important for the general population, being crucial for HIV-positive women, emphasizing the importance of the distribution of Cervarix and Gardasil, which target the most cancerous genotypes. 50 Other studies have shown the effectiveness and necessity of including 9-valent vaccine due to the coverage of other genotypes. 40,51,52…”

“…21 Vaccination is important for the general population, being crucial for HIV-positive women, emphasizing the importance of the distribution of Cervarix and Gardasil, which target the most cancerous genotypes. 50 Other studies have shown the effectiveness and necessity of including 9-valent vaccine due to the coverage of other genotypes. 40,51,52 The low number of participants included and the absence of important data (such as HIV viral load, CD4 + /CD8 + Tcell count and vaccination) in some articles are some of the limitations of this systematic review.…”

There’s Much Yet to be Done: Diverse Perspectives on HPV Vaccination

“…Another article looks at genital HPV prevalence among adult immigrants living in the U.S., finding that high-risk HPV prevalence was lower among this population compared to those born in the U.S. 69 An addition paper evaluated incident genital HPV infections in adult women living with HIV/AIDS, reporting that 35% of incident infections could have been prevented by the 9-valent vaccine. 70 A final article examined the hypothesis that obesity status might be associated with greater risk of HPV infection in the anal canal due to an increased associated risk of micro and macro tears in the epithelium. 71 Results were mixed but certainly support universal gender-neutral HPV vaccination.…”