Department of Obstetrics and Gynecology, Saint Pierre University Hospital 322, Belgium Université Libre de Bruxelles (ULB)-Free University of Brussels (ULB-VUB), Brussels, Belgium.
Infectious Disease Department Saint Pierre University Hospital 322, Université Libre de Bruxelles (ULB), Brussels, Belgium.
HIV Med. 2023 Aug;24(8):877-892. doi: 10.1111/hiv.13490. Epub 2023 Apr 16.
Women with HIV are more often infected with human papillomavirus (HPV) and are more prone to develop precancerous cervical lesions (squamous intraepithelial lesions, SIL) and invasive cervical cancer (ICC) than HIV-negative women.
This scoping-review analyses the impact of HIV on HPV prevalence, incidence and evolution to SIL and ICC.
We selected all PubMed systematic reviews and meta-analyses published between January 2000 and July 2021 reporting data about HPV, cervical intraepithelial neoplasia (CIN), SIL and ICC prevalence, incidence and evolution in women with HIV. A hypothetical model comparing the history of HPV infection in HIV-negative, combined antiretroviral therapy (cART)-treated and -untreated women with HIV was built.
Data from 11 meta-analyses and 10 systematic reviews were selected, which included between 770 and 236 127 women with HIV. Women with HIV have a 3 to 6 times higher risk of being infected by HPV, of progression to high-grade SIL (HSIL) and to ICC. These risks are exacerbated when the CD4 cell counts are low and when they are not using cART, whereas these risks are reduced by 20%-30% when they are optimally treated with cART and have had a suppressed HIV viral load for at least 2 years. In our model, we illustrated that optimal HIV treatment and preventing HIV reduce the number of ICC cases by 2.5 and 6 times, respectively.
Optimal treatment and care of HIV patients are essential to reduce their prevalence of ICC, as are preventive strategies which include HPV vaccination, cervical cancer screening strategies and treatment of HSIL.
与 HIV 阴性女性相比，HIV 感染妇女更容易感染人乳头瘤病毒（HPV），并且更容易发展为癌前宫颈病变（鳞状上皮内病变，SIL）和浸润性宫颈癌（ICC）。
本范围综述分析了 HIV 对 HPV 流行率、发病率以及向 SIL 和 ICC 进展的影响。
我们选择了 2000 年 1 月至 2021 年 7 月期间发表的所有关于 HPV、宫颈上皮内瘤变（CIN）、SIL 和 ICC 流行率、发病率和演变的 PubMed 系统评价和荟萃分析，这些分析报告了 HIV 女性的数据。建立了一个假设模型，比较了 HIV 阴性、接受联合抗逆转录病毒治疗（cART）治疗和未治疗的 HIV 女性的 HPV 感染史。
共选择了 11 项荟萃分析和 10 项系统评价的数据，其中包括 770 至 236127 名 HIV 女性。与 HIV 阴性女性相比，HIV 女性感染 HPV 的风险增加了 3 至 6 倍，发生高级别 SIL（HSIL）和 ICC 的风险也增加了。当 CD4 细胞计数较低且未使用 cART 时，这些风险会加剧，而当她们接受最佳的 cART 治疗且 HIV 病毒载量至少抑制 2 年时，这些风险会降低 20%-30%。在我们的模型中，我们表明，优化 HIV 治疗和预防 HIV 分别可使 ICC 病例减少 2.5 倍和 6 倍。
优化 HIV 患者的治疗和护理对于降低其 ICC 患病率至关重要，预防策略包括 HPV 疫苗接种、宫颈癌筛查策略和 HSIL 治疗。
