Combination antiretroviral therapy reduces the detection risk of cervical human papilloma virus infection in women living with HIV.
OBJECTIVE
Data on the effect of combination antiretroviral therapy (cART) on cervical human papilloma virus (HPV) infection are both limited and conflicting. We aimed to determine the effect of the initiation of cART for HPV genotype detection on cervical samples in HIV-infected South African women.


METHODS
Prospective cohort study.


METHODS
Generalized estimating equation was performed to estimate parameters of mixed-effects logistic regression models of cART on HPV cervical detection risk, adjusting for time-dependent covariates CD4 T-cell count, sexual activity and excision treatment. Ratio of odds ratios (ORs) was computed to compare the pooled cART effect on lower vs. high-risk HPV genotype groups, to the effect of cART on the risk of HPV-16 detection.


RESULTS
Of the 300 patients, 204 (68%) were commenced on ART during follow-up, as they met the criteria for cART initiation. cART significantly reduced the risk for detection of HPV by 77% [OR 0.23, 95% confidence interval (CI) 0.15-0.37]. cART significantly reduced the risk of HPV-16 detection (OR 0.50, 95% CI 0.37-0.67). Every month on cART significantly reduced the detection risk of any HPV type by 9% (OR 0.91, 95% CI 0.89-0.94). The protective effect of cART on the detection risk for the low-risk HPV genotype group was significantly less than the protective effect of cART on the detection risk of HPV-16 (ratio of ORs 1.35, 95% CI 1.22-1.50).


CONCLUSIONS
cART significantly reduced cervical HPV infection. This effect was dependent on the duration of exposure to cART and is the mechanism by which cART may improve the outcome of dysplasia in HIV-infected women.
aDepartment of Medicine and Centre for Infectious Diseases (CID) bDepartment of Obstetrics and Gynecology cDepartment of Pathology, Division of Medical Virology, Stellenbosch University, Faculty of Health Sciences dNational Health Laboratory Services (NHLS), Western Cape Region, Tygerberg Hospital (Coastal) eDepartment of Interdisciplinary Health Sciences, Centre for Evidence-Based Healthcare, Biostatistics Unit, Stellenbosch University, Faculty of Health Sciences, Cape Town, South Africa fDepartment of Epidemiology, Pittsburgh Graduate School of Public Health, Infectious Diseases Epidemiology Research Program, Pittsburgh, Pennsylvania gDepartments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Michèle D
MD
Zeier
Matthys H
MH
Botha
Susan
S
Engelbrecht
Rhoderick N
RN
Machekano
Graeme B
GB
Jacobs
Shahieda
S
Isaacs
Marije
M
van Schalkwyk
Haynes
H
van der Merwe
Deidre
D
Mason
Jean B
JB
Nachega
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000821:virology*; D060085:Coinfection; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control; D011446:Prospective Studies; D055815:Young Adult
D004279:DNA, Viral