The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women

Abstract

HAART altered the course of HPV disease in HIV-infected women, reducing progression and increasing regression. As HPV disease is a common sex-specific manifestation of HIV disease this effect of HAART would be a major additional benefit from this modality of therapy.

Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

“…There are conflicting data on the impact of ART on HPV infection, CIN, and cervical cancer. While some studies have shown a slight reduction in CIN and cervical cancer rates among HIV-positive patients receiving ART, it is likely that this benefit depends on viral load and CD4 count [34][35][36]49]. However, our analysis suggests that cervical cancer screening using HPV DNA testing remains cost effective over the entire possible range of assumptions on this issue.…”

“…We assumed that 50k of patients with acquired immunodeficiency syndrome (AIDS) (defined as CD4 count b200 cells/mm 3 ) would receive antiretroviral therapy (ART). Based on input from clinical experts, we assumed that the relative risk of progression and regression of HPV and CIN among patients receiving ART for HIV infection is mid-way between the relative risk for HIVnegative patients and untreated HIV-positive patients [34][35][36]. Natural history data were used to estimate risk of death due to AIDS (Table 1) [23,37].…”

Gynecologic issues in the HIV-infected woman

“…One prospective trial of HIV-infected women with SILs at baseline demonstrated equivalent rates of progression and regression if taking no therapy, reverse transcriptase inhibitors, or HAART (75). Yet another large study demonstrated a significant increase in regression and decrease in progression with HAART (76). The effect of HAART on SILs is likely mediated through immune reconstitution, but some propose an additional direct antiviral effect of HAART on HPV (73,74).…”

Neoplasias en pacientes con infección por VIH: Estudio descriptivo de 129 casos en el período 1993-2010

“…Por un lado, se sabe que la propia infección por el VIH condiciona defectos en la inmunidad celular, con la subsiguiente alteración en los sistemas de vigilancia y supresión de aquellos virus con potencial oncogénico 15 , teniendo en cuenta que muchos de estos pacientes están co-infectados por otros virus como el papiloma humano (VPH), Epstein Barr (VEB), hepatitis B (VHB) y hepatitis C (VHC). Interesantes estudios han mostrado la asociación de determinados virus con cáncer, como el caso del LH con el VEB 16,17 , el hepatocarcinoma con el VHB y el VHC 18,19 o el cáncer de ano /pene /vulva /cavidad oral con el VPH [20][21][22][23][24][25][26][27][28][29] . Por otro lado, se cree que el propio tratamiento anti-retroviral conlleva una activación crónica del sistema inmune, y por tanto, podría contribuir a incrementar el riesgo de algunos tumores.…”