The Impact of HAART on HPV-Related Cervical Disease

David      H. Adler

Abstract

Purpose of Review: Highly active antiretroviral therapy (HAART) has had an unequivocally positive impact on morbidity and mortality in HIV-infected individuals. These benefits have clearly extended to some HIV-related malignancies, including Kaposis sarcoma and non-Hodgkins lymphoma. The impact of HAART on cervical cancer, however, remains uncertain. The objective of this review is to summarize the last ten years of registry-based and clinical research into the impact of HAART on human papillomavirus (HPV) related cervical disease. Relevant Findings: Compared to their HIV-uninfected counterparts, HIV-infected women have an increased prevalence of HPV infection, increased risk of progression of HPV-related cervical disease, and an increased risk of invasive cervical cancer. While the partial immune reconstitution afforded by HAART might be expected to decrease susceptibility to HPV infection and cervical disease, the local effects of improved immunosurveillance on the cervix are uncertain and the increased longevity of patients on HAART may increase risk of exposure to HPV and provide the time required for progression of cervical disease. Registry-based evidence has been consistent in identifying the lack of decrease in cervical cancer incidence in the HAART era. Clinical research on the subject, however, has produced conflicting evidence with regards to both the effect of HAART on HPV infection and its impact on cervical disease progression/regression. Summary: The incidence of cervical cancer has not decreased in the HAART-era. Furthermore, clinical research has not shown a clear benefit of HAART in decreasing HPV-related cervical disease in HIV-infected women. A better understanding of this subject will have an impact on cervical disease surveillance practices.

Keywords: human immunodeficiency virus-infected adults, human immunodeficiency virus-1, HR-HPV DNA, cervical cytology, cervical lesions, Swiss HIV Cohort Study, HPV16, CD4, immunosuppression, HIV-infected women, squamous intraepithelial lesions, oncogenic genotypes, AIDS, highly-active antiretroviral therapy, human immunodeficiency virus, immunosurveillance, non-Hodgkin's lymphoma, Kaposi's sarcoma, antiretroviral therapy, HPV-Related Cervical Disease, HIV, Cervical cancer, Cervical dysplasia, HAART, Human papillomavirus, HPV, smoking, intraepithelial neoplasia, HIV-seropositive women, human papillomavirus-associated genital lesions