Background
HIV infection is associated with an increased risk of human papillomavirus (HPV) acquisition, decreased clearance of HPV, and increased risk of precancerous lesions and cervical cancer. Despite the availability of antiretroviral therapy (ART), there is paucity of data describing the association between sustained HIV viral suppression and HPV infection. Achieving durable HIV viral suppression could be a potential strategy for mitigating adverse outcomes associated with high-risk HPV infections.
Methods
We conducted retrospective data analysis and included all WLHV who had received cervical cancer screening using HPV typing as part of a pilot between June and September 2024 within an extensive HIV program in Western Kenya. Deidentified data were abstracted from electronic medical records, including age, nadir CD4 count and ART duration, identified a priori as potential confounders. Sustained viral suppression, defined as an undetectable viral load of fewer than 50 copies per millimetre from ART initiation, was our exposure of interest. Our outcome was defined as the presence of high-risk HPV serotypes from self-collected cervical samples. Log binomial regression was used to estimate the odds of high-risk HPV infection by sustained viral suppression.
Results
Overall, we included 795 WLHIV, of whom 323 (40.6%) had sustained viral suppression, whereas 472 (59.4%) had periods of non-suppression from the time of ART initiation. The age and duration of ART did not differ based on viral suppression, with a median of 41 years (IQR 36-46) and 9.1 years (IQR 4.8-14.8), respectively. WLHV with a nadir CD4 count of less than 200 cells per millimetre was 36 (11.1%) among those with sustained HIV viral suppression and 40 (8.5%) among those with periods of being unsuppressed. The prevalence of high-risk HPV infection was 40.7% and 42.3% when comparing those with sustained HIV viral suppression versus those who did not, respectively. WLHIV who did not have sustained HIV viral suppression had 1.5 times higher odds of having high-risk HPV infection (aOR=1.5, 95% CI, 1.3-1.6, p-value < 0.001).
Conclusions
The odds of high-risk HPV infection were higher among WLHV who had periods of HIV non-suppression after adjusting for nadir CD4, duration on ART and age.