ART reduces HPV and cervical cancer in women with HIV

Women with HIV on ART had a lower prevalence of high-risk HPV infection, high-grade cervical lesions and invasive cervical cancer than women who were not receiving ART, according to results of a recent meta-analysis.

“Our findings highlight the importance of early ART initiation (before reaching a low nadir CD4 cell count) and sustained effectiveness, as evidenced by duration, high adherence, virological control and CD4 cell recovery, in controlling HPV infection and cervical disease progression,” Helen Kelly, PhD, assistant professor in the clinical research department at London School of Hygiene and Tropical Medicine, and colleagues wrote in The Lancet HIV.

According to the researchers, women with HIV have a higher prevalence of high-risk HPV than the general population and are more likely to have persistent infection and progression of cervical intraepithelial neoplasia lesions. However, the impact of ART on HPV and cervical cancer is poorly understood.

Although most studies found a protective effect of ART on the incidence and progression of cervical lesions, fewer studies exist from Latin America and Asia and were less likely to report any protective association of ART. The researchers noted, however, that women enrolled in these studies may have received treatment based on older HIV guidelines that recommend initiating ART at lower CD4 cell count thresholds, and therefore may have a weakened HPV-specific mucosal immune response.

“The current recommendation of encouraging earlier ART initiation, coupled with rapid virological control and sustained adherence is likely to lead to an earlier and possibly more functionally complete mucosal immune reconstitution,” they wrote. “We expect that this should in turn lead to a more rapid clearance of high risk HPV and ultimately reducing cervical cancer incidence in this high-risk population.”

In addition to initiating early ART, Kelly and colleagues recommended frequent HPV screening among women with HIV and called for the development of rapid point-of-care tests to improve screening programs in low- and middle-income countries with a high prevalence of HPV and HIV.