HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer.
HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer.
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DOI：
10.1097/qad.0000000000001765
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发表时间：
2018-03-27
期刊：
影响因子：
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通讯作者：
Barnabas RV
中科院分区：
文献类型：
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作者：
Liu G;Sharma M;Tan N;Barnabas RV
HIV阳性妇女的人乳头瘤病毒（HPV）感染率和宫颈癌（CC）发病率高于HIV阴性妇女，部分原因是HIV对HPV发病机制的修饰作用。我们综合了有关HIV对HPV自然史影响的文献。系统回顾和荟萃分析我们检索了文献中评估HPV获得和持续性或癌前进展的研究。使用固定效应模型总结了HIV状态、CD 4+细胞计数、病毒载量和抗逆转录病毒治疗（ART）的HPV自然史数据。总体而言，识别的1845篇摘要中有38篇符合纳入标准。与HIV阴性女性相比，HIV阳性女性的HPV感染率较高（相对风险[RR汇总]=2.64，95%置信区间[CI] 2.04-3.42），HPV清除率较低（风险比[HR汇总]=0.72，95% CI 0.62-0.84）。HPV感染率随CD 4下降而升高，在接受ART治疗的病毒抑制患者中降低。HIV与低度鳞状上皮内病变（LSIL）（RR合并=3.73，95% CI 2.62-5.32）和高度鳞状上皮内病变（HSIL）（HR合并=1.32，95% CI 1.10-1.58）的发生率较高相关，主要是由于HPV持续性增加。ART降低了从正常细胞学到LSIL的进展（HR合并=0.65，95% CI 0.52-0.82），但不能降低HSIL。CC发病率与HIV阳性相关（RR=4.1，95%CI 2.3-6.6），但与ART无关。HIV阳性妇女感染HPV的风险较高，与CD 4计数呈负相关。ART可能通过免疫重建降低HPV感染，增加清除率，并减少癌前病变进展。虽然我们的一些结果受到少量研究的限制，但我们的研究可以为CC预防的筛查指南和数学模型提供信息。
HIV-positive women have higher human papillomavirus (HPV) prevalence and cervical cancer (CC) incidence than HIV-negative women, partly due to HIV’s modifying effect on HPV pathogenesis. We synthesized the literature on the impact of HIV on HPV natural history. Systematic review and meta-analysis We searched the literature for studies evaluating HPV acquisition and persistence or precancer progression by HIV status. Data on HPV natural history by HIV status, CD4+ cell counts, viral load, and antiretroviral therapy (ART) were summarized using fixed effect models. Overall, 38 of 1845 abstracts identified met inclusion criteria. HIV-positive women had higher HPV acquisition (relative risk [RRpooled]=2.64, 95% confidence interval [CI] 2.04–3.42) and lower HPV clearance (hazard ratio [HRpooled]=0.72, 95% CI 0.62–0.84) than HIV-negative women. HPV acquisition was higher with declining CD4 and was lower in those virally suppressed on ART. HIV was associated with higher incidence of low-grade squamous intraepithelial lesions (LSIL) (RRpooled=3.73, 95% CI 2.62–5.32) and high-grade squamous intraepithelial lesions (HSIL) (HRpooled=1.32, 95% CI 1.10–1.58), largely due to increased HPV persistence. ART lowered progression from normal cytology to LSIL (HRpooled=0.65, 95% CI 0.52–0.82), but not HSIL. CC incidence was associated with HIV positivity (RR=4.1, 95% CI 2.3–6.6), but not with ART. HIV-positive women have higher risk of acquiring HPV, with risk inversely associated with CD4 count. ART lowered HPV acquisition, increased clearance, and reduced precancer progression, likely via immune reconstitution. While some of our results are limited by small number of studies, our study can inform screening guidelines and mathematical modeling for CC prevention.