April 11, 2013
Women infected with HIV also have high rates of infection with high-risk strains of human papillomavirus (HPV) that cause cervical cancer. Researchers in Brussels, Belgium, have proved that an undetectable viral load and sustained immune reconstitution in women with HIV infection reduces risk of persistent cervical infection with strains of HPV. The researchers conducted a prospective study of 652 women with HIV infection who had regular Pap tests between 2002 and 2011. They investigated factors associated with prevalent, incident, and persistent high-risk cervical HPV infection. The majority of the participants (84 percent) were from sub-Saharan Africa and their median age at first HPV screening was 38 years. Median baseline CD4 cell count was 426 cells per cubic millimeter. More than three-quarters (79 percent) of participants were receiving HIV therapy and 56 percent had an undetectable viral load. The researchers followed up with participants for a median of 103 months.
Statistical analysis showed that a low CD4 cell count (above 500 cells per cubic millimeter) and antiretroviral treatment for two or more years with an undetectable viral load were associated with a reduced risk of high-risk HPV infection. Fifty-four participants with a negative baseline screen were later infected with a high-risk HPV strain. Of the women with HPV, 63 cleared the infection, but it persisted in 77 of them. Researchers found a significant and independent association with undetectable viral load for 24 or more months and clearance of the infection. They also examined factors associated with high-risk cervical HPV infection during the study.
Findings indicated that older age, longer period of time with high CD4 cell count, and longer time with viral suppression were associated with lower risk of carrying high-risk strains. Age under 30 years was a risk factor for infection during the study; risk decreased significantly if CD4 cell count went above 500 cells per cubic millimeter for at least 18 months and viral load was low for four or more months. The authors believe that further research is needed to determine whether early HIV therapy can lower the risk of high-risk HPV infection and cervical cancer.
The full report, "Sustained Viral Suppression and Higher CD4 Cell Count Reduces the Risk of Cervical Persistent Infection with High Risk Human Papillomavirus in HIV-Positive Women," was published online in the Journal of Infectious Diseases (2013; doi:10.1093/infdis/jit090).