Longer duration of anti-retroviral therapy is associated with decreased risk of human papillomaviruses detection in Kenyan women living with HIV

Abstract

Objective: A longitudinal study was conducted among women living with HIV in Kenya to determine if duration of anti-retroviral (ART) usage altered detection and persistence of oncogenic (high-risk) human papillomaviruses (HR-HPV). Methods: Women living with HIV without cervical dysplasia were enrolled at a cervical cancer screening clinic. Three cervical swabs, HIV viral loads, and CD4 cell counts were obtained at enrollment and at two annual visits. HPV genotyping was performed on swabs (Roche Linear Array). Linear regression models assessed effects of ART duration on HR-HPV detection and persistence. Results: Seventy-seven women, median age 38 years, completed three study visits and were included in the analysis. The mean time from HIV diagnosis to enrollment was 9.6 years (SD 3.9 years). The mean ART duration was 6.2 years (SD 3.1 years). Most women had undetectable HIV viral loads and CD4 cell counts above 500 cells/L. Each additional year of ART use reduced the likelihood of detection of HR-HPV by 10–15% and persistent detection of A9 HR-HPV by 20%. Conclusion: Among Kenyan women living with HIV, longer duration of ART use was associated with significantly reduced risk of all detection and persistent detection of HR-HPV.

HPV co‐infections with other pathogens in cancer development: A comprehensive review

“…Different researchers reported a lower prevalence of cervix HPV infection in PLWH receiving ART compared to untreated patients. 145 In addition, a longer duration of ART among women was associated with a lower prevalence of HR-HPV infection in Kenya 146 suggesting higher immune control and clearance of HPV infection in the cervix. 145 Lower progression risk from low-grade squamous intraepithelial lesions to high-grade squamous intraepithelial lesions was reported among women who used ART.…”

Cervical cancer prevention and control in women living with human immunodeficiency virus

“…Notwithstanding these significant methodologic limitations, meta‐analyses of the available literature suggest that WLWH have a higher risk of HPV acquisition, presumably due to shared behavioral risk of sexual transmission but also likely due to immune dysregulation (presumably because more incident HPV infections, even those destined to clear, persist long enough to be detected 42 , 43 ), as evidenced by the inverse association between HPV acquisition risk and markers of HIV control/immune status (eg, CD4 counts). 43 , 44 , 45 WLWH have an approximately ≥2‐fold prevalence of HPV compared with HIV‐negative women.…”

“…Notwithstanding these significant methodologic limitations, meta‐analyses of the available literature suggest that WLWH have a higher risk of HPV acquisition, presumably due to shared behavioral risk of sexual transmission but also likely due to immune dysregulation (presumably because more incident HPV infections, even those destined to clear, persist long enough to be detected 42 , 43 ), as evidenced by the inverse association between HPV acquisition risk and markers of HIV control/immune status (eg, CD4 counts). 43 , 44 , 45 WLWH have an approximately ≥2‐fold prevalence of HPV compared with HIV‐negative women. 46 , 47 , 48 , 49 , 50 , 51 , 52 Among WLWH, HPV prevalence was lower among those receiving ART (vs not), 51 , 53 , 54 , 55 , 56 , 57 , 58 , 59 on longer (vs shorter) duration of ART, 20 , 54 with higher (vs lower) CD4 counts, 51 , 54 , 55 , 56 , 57 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 and with a lower HIV viral load.…”

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

“…A meta-analysis including 6500 women infected by HIV reported a lower HR-HPV prevalence in the pooled analysis than in those not receiving ART (with a crude OR of 0·82) [ 71 ]. In addition, an observational study conducted in Kenya also reported that a longer duration of ART was associated with a lower HPV infection prevalence of all HPV genotypes and HR-HPV specifically (with ORs, of 0.90 and 0.87, respectively) [ 72 ]. This could reflect better immune control and viral clearance of HPV infection in the cervix among women receiving ART, changes in risky sexual behaviors, or a combination of both.…”