HPV Infection and Cervical Abnormalities in HIV Positive Women in Different Regions of Brazil

Human papillomavirus (HPV) is a STD that is today common all over the world. Patients with the high-risk genotypes (HR-HPV) are considered to be at risk of developing squamous cell cervical carcinoma (SCC). However, the HPV virus by itself does not cause SCC as it is believed that other factors contribute to the beginning and progression of lesions. Studies conducted previously have exposed the connection between HPV infection and SCC development among HIV-infected women in many regions all over the world, especially those in low and middle-income countries. Brazil is considered a low and middle-income country.

A review by Freitas and others sought to highlight the current knowledge about HPV infection and cervical abnormalities in HIV+ women in Brazil. The researchers chose Brazil because it is an ideal setting to assess HIV impact on SCC development and is also a model of low and middle-income countries and with low resource settings. The reviewers combed PubMed, MEDLINE, Google Scholar and Lilacs in search of full-text papers and abstracts published in either English or Portuguese between 2010 and 2014. The researchers used MeSH terms including: papillomavirus infections, HIV infections, papillomaviridae, pregnancy, Brazil, HIV, HPV and biological markers. Additional publications were also sourced from the reference lists of the selected papers.

The review came across several studies that note that SCC risk is closely related to women’s immune status. The studies also indicated that since 1993, SCC has been classified as a disease that defines AIDS. According to studies, it is easy to examine HPV infection in HIV+ women because they are more exposed to infection and less prone to clear the virus. This increases the risk of developing cervical lesions and cancer later on. HIV infection triggers a gradual loss of CD4+. Low CD4+ is linked to increased HPV infection and viral tenacity. Additionally, being infected with multiple HPV genotypes is a common link to HIV/AIDS and cancer. There have been reports of a 2- to 22-fold amplified risk of SCC among HIV+ women compared to HIV- women living in the same geographical area. The studies linking high prevalence of cervical lesions among HIV+ women also stress that the immune response is also a major factor in the development of SCC.

HPV Vaccine

According to the review, even though the frequency of total cancers has reduced in HIV+ individuals due to the introduction of highly active antiretroviral therapy (HAART), this frequency has not reduced for certain HPV-related cancers. Even though more and more women are able to survive HIV due to HAART, there is an increased chance for the oncogenic viral infections to progress into malignancies, more so in oral, genital and anal cancers associated with HPV. The recent approval of the use of 9-valent HPV vaccine in U.S. STD clinics increases chances of dramatically decreasing the risk of persistent HR-HPV infections and HPV-related cancers. If the vaccine is administered at right vaccination onsets, the HPV vaccine will tremendously impact cancer screening as well. Understanding the specific frequency and distribution of HPV genotypes in different geographic locations will also help produce further awareness into whether this new vaccine has any potential and value.

The original paper can be found here: http://www.apocpcontrol.org/paper_file/issue_abs/Volume16_No18/8085-8091%2011.3%20Beatriz%20C%20Freitas%20[MINI-REVIEW].pdf