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

Abstract

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.

Tracking HPV Infection, Associated Cancer Development, and Recent Treatment Efforts—A Comprehensive Review

“…Moreover, high-risk entities of HPV often lead to cervix and anogenital cancer by co-infection of HPV and HIV in patients [ 53 ]. To prove the underlying cellular mechanisms and develop treatment options, scientists are working on patients with HIV and HPV co-infection [ 54 ]. The major cause of co-infection is the immune system vulnerability generated in HIV patients, which provides a gateway for HPV abundance and oncogenic progression in such patients.…”

Real-life cohort experience after implementing HIV pre-exposure prophylaxis for one year in northwest Spain

“…In addition, SIL surveillance programs have been developed for cervix and anal cancer prevention which have led to a decline in the incidence of HPV-driven dysplasia. Anal squamous cell carcinoma is a rare disease among the general population, but its incidence is disproportionally high in HIV-infected MSM ( 25 ). Whether anal SIL surveillance is necessary among HIV-uninfected MSM remains controversial, and very little data are available in this respect ( 14 ).…”

Distribución de virus de papiloma humano de alto riesgo oncogénico y otras infecciones de transmisión sexual en mujeres paraguayas con y sin virus de la inmunodeficiencia humana

“…En relación a la frecuencia de VPH-AR, no existió diferencia significativa en la frecuencia de VPH-AR observada en ambas poblaciones. Ahora bien, cuando clasificamos en grupos etarios en mayores de 30 años la infección de VPH-AR no disminuye en las mujeres VIH positivas a diferencia de las mujeres VIH negativas donde con la edad la frecuencia de VPH-AR si disminuye que es lo esperable, porque muchas infecciones son eliminadas por el sistema inmune (25) . Las mujeres VIH positivas tienen un mayor riesgo de cáncer invasivo y el cáncer parece ocurrir a una edad más joven con una posible reactivación de la infección por VPH latente (26) .…”