HPV infection, cervical disease prevalent in HIV-infected women on HAART: CD4 count & competence may be crucial to persistence of high-risk HPV

Sept 20, 2001

WESTPORT, CT (Reuters Health) - High-risk human papillomavirus (HR-HPV) infections and squamous intraepithelial lesions (SILs) persist in many HIV-infected women despite highly active antiretroviral therapy (HAART), Italian researchers report in The Journal of Infectious Diseases for September.

Dr. Flavia B. Lillo and colleagues from San Raffaele Hospital, Milan, determined the effect of HAART on HR-HPV infections and related cervical lesions by prospectively evaluating virologic and cytologic markers of HPV infection in 163 HIV-infected women. Twenty-seven of the women were untreated, 62 were being treated with reverse transcriptase inhibitors, and 74 were being treated with HAART.

The researchers report that 65% of the 163 women had evidence of HPV infection at baseline. Further analysis revealed low-grade SILs in 20.2% of subjects and high-grade SILs in 6.2%.

Treatment with HAART had no demonstrable effect on the persistence of HR-HPV or evolution of SILs, according to the team. "Neither the prevalence and persistence of HR-HPV infection nor the natural history of the related cervical lesions differed in treated versus untreated women," they report.

After adjustment for gynecologic therapy, the only variable significantly associated with the persistence of HR-HPV infection was a CD4 cell count <350 cells/µL. Only HAART-treated subjects experienced a significant increase in CD4 cell counts over an average followup period of 15.4 months (p < 0.001).

"Our results indicate that HPV cervical infection and related disease persist in a high proportion of women receiving HAART, particularly those with the longest history of HIV infection, and suggest that, regardless of antiretroviral regimen and its effect on HIV replication, the number (and probably competence) of CD4 cells is crucial," the authors write.

Of interest, they add, is the finding of a significant reduction in the incidence of new HPV-16 and HPV-18 infections in women treated with HAART, compared with untreated and reverse transcriptase-treated women (p = 0.043). "This may suggest that the immune recovery induced by HAART can (in patients with higher CD4 cell counts) duplicate that found in the general population (i.e., early treatment results in regression of acute HPV infections at higher risk for evolution but in less effect on well-established or advanced HPV disease)."

Dr. Farmer and colleagues say all HIV-infected women should be routinely monitored for the emergence of high-grade SILs and cervical cancer.

J Infect Dis 2001;184:547-551.