Abstract
BackgroundThe implementation of highly active antiretroviral therapy (HAART) among HIV-positive patients results in immune reconstitution, slower progression of HIV disease, and a decrease in the occurrence of opportunistic infections. However, the impact of HAART on cervical human papillomavirus (HPV) infection, clearance, and persistence in high-risk adolescents remains controversial.MethodsHIV-positive and high-risk HIV-negative female adolescents were enrolled in the Reaching for Excellence in Adolescent Care and Health (REACH) longitudinal cohort study. At each semi-annual clinical visit, cervical lavage samples were tested for 30 HPV types. Type-specific and carcinogenic risk-specific HPV prevalence and incidence were compared in 373 eligible participants: 146 HIV-negative female adolescents with a median follow-up of 721.5 [IQR: 483-1301] days and 227 HIV-positive female adolescents. Of the 227 HIV-positive participants, a fixed set (n = 100) were examined both before and after HAART initiation; 70 were examined only before HAART initiation; and 57 were examined only after HAART initiation, with overall median follow-up of 271 [IQR: 86.5-473] and 427.25 [IQR: 200-871] days respectively for before and after HAART initiation.ResultsOf the 373 eligible participants, 262 (70%) were infected with at least one type of HPV at baseline, and 78 of the remaining 111 (70%) became infected with at least one type of HPV by the end of the study. Overall, the incidence and prevalence of HPV types 58, 53/66, 68/70, and 31/33/35 were much higher than the established carcinogenic and HPV vaccine types 16 and 18, especially in HIV-positive females both before and after HAART initiation. Baseline prevalence for individual high-risk HPV types ranged, depending on type, from 0.7-10%, 1-17%, and 1-18% in the HIV-negative group, the HIV-positive before HAART initiation group, and the HIV-positive after HAART initiation group, respectively. Likewise, the incidence ranged, depending on HPV type, from 0.64-9.83 cases/100 PY, 3.00-12.80 cases/100 PY, and 1.49-17.05 cases/100 PY in the three groups, respectively. The patterns of each HPV type infection, clearance, and persistence did not differ considerably before or after the introduction of HAART and were clearly independent of CD4+ change within the short post-HAART follow-up period.ConclusionsHAART did not immediately affect the incidence of type-specific HPV infections within a short-period follow-up; however, future studies are warranted in larger populations to evaluate HAART's impact over longer periods.
Highlights
The implementation of highly active antiretroviral therapy (HAART) among HIV-positive patients results in immune reconstitution, slower progression of HIV disease, and a decrease in the occurrence of opportunistic infections
There were a total of 373 eligible female adolescent participants (146 HIV-negative and 227 HIV-positive) in the REACH cohort, of whom 262 (70%) were infected with at least one human papillomavirus (HPV) type at baseline
The prevalence and incidence estimates were based on 146 HIV-negative females, 170 for the before HAART initiation period (100 of whom initiated HAART during the study and were censored up until that date, and another 70 who were never on HAART), and 157 for the after HAART initiation period (57 of whom initiated HAART immediately after enrollment and contributed no before HAART initiation data, and the 100 in the case-crossover subset with at least two follow-up visits before and after HAART with HPV data)
Summary
The implementation of highly active antiretroviral therapy (HAART) among HIV-positive patients results in immune reconstitution, slower progression of HIV disease, and a decrease in the occurrence of opportunistic infections. The impact of HAART on cervical human papillomavirus (HPV) infection, clearance, and persistence in high-risk adolescents remains controversial. Human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection (STI) in the United States (U.S.) and the world [1,2]. In the NHANES survey, the overall HPV prevalence was 24.5% (95% CI, 19.6%-30.5%) among females aged 14-19 years [3]. An estimated 80% of all sexually active females will have been exposed to HPV by age 50 [5]. Persistent HPV infection, along with environmental and genetic factors, predisposes individuals to the development of highgrade cervical intraepithelial neoplasia (CIN) [11] and, in some cases, to subsequent progression to cancer [12]. Other clinical manifestations of HPV infection include anogenital warts and recurrent respiratory papillomatosis, as well as anal, vulvar, vaginal, penile, and head and neck cancers
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