International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan, Ghent, Belgium.
Primary Health Care Services, International Committee of the Red Cross, Geneva, Switzerland.
PLoS One. 2019 Mar 11;14(3):e0213086. doi: 10.1371/journal.pone.0213086. eCollection 2019.
Invasive cervical cancer is the most prevalent cancer among women in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) emitted recommendations to start Highly Active Antiretroviral Therapy (HAART) regardless of CD4 count. Although HAART has been shown to reduce the prevalence of high-risk human papillomavirus (HR-HPV) genotypes, it is unclear whether it confers a protective effect specifically for HPV 16. This review summarizes the existing evidence regarding the effect of HAART on HPV 16 infection, as this genotype may not be influenced by immunity level and explores its implications for Sub Saharan Africa. A comprehensive literature review was undertaken and quality assessment was carried out on the selected papers. Four cohort studies and three cross-sectional studies were identified for which the overall quality score assessment ranged from weak/moderate (Score of 1.8) to strong (Score of 3). The evidence yielded by our review was conflicting. Thus, the high heterogeneity between study populations and results did not allow us to draw any firm conclusions as to whether HAART has an impact on HPV 16 acquisition/prevalence. As only three studies were conducted in Africa, there are insufficient grounds for solid comparison between geographic regions. In light of inadequate data, HPV unvaccinated women on HAART should still receive more frequent follow-up.
在撒哈拉以南非洲，浸润性宫颈癌是女性中最常见的癌症。2013 年，世界卫生组织（WHO）发布建议，无论 CD4 计数如何，都应开始高效抗逆转录病毒治疗（HAART）。尽管 HAART 已被证明可以降低高危型人乳头瘤病毒（HR-HPV）基因型的流行率，但尚不清楚它是否对 HPV 16 具有特定的保护作用。本综述总结了现有关于 HAART 对 HPV 16 感染影响的证据，因为这种基因型可能不受免疫水平的影响，并探讨了其对撒哈拉以南非洲的影响。我们进行了全面的文献综述，并对所选论文进行了质量评估。确定了四项队列研究和三项横断面研究，其整体质量评分评估范围从弱/中度（评分 1.8）到强（评分 3）。我们综述的证据相互矛盾。因此，研究人群和结果之间的高度异质性使得我们无法得出任何关于 HAART 是否对 HPV 16 感染/流行率有影响的明确结论。由于只有三项研究在非洲进行，因此在地理区域之间进行可靠比较的依据不足。鉴于数据不足，仍应对接受 HAART 的未接种 HPV 的女性进行更频繁的随访。
