The interactions of antiretroviral therapy (ART) with high-risk (HR) HPV and cervical lesions in women living with HIV (WLHIV) are poorly understood. We reviewed HR-HPV and cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesions (SIL) outcomes in ART-taking compared to ART-naive WLHIV.
We performed a systematic review and meta-analysis by searching Medline and Embase databases for cross-sectional or cohort studies from 1 January 1996 to 6 November 2016 that reported the association of ART with prevalence of HR-HPV or prevalence, incidence, progression or regression of CIN or SIL abnormalities. We performed random-effects meta-analyses to estimate summary statistics. Heterogeneity was examined using the I2 statistic.
A total of 6,441 and 8,262 WLHIV were included from 29 studies evaluating the association of ART with prevalence of HR-HPV and high-grade CIN (CIN2+) or SIL (HSIL+), respectively. ART users had lower HR-HPV prevalence than ART-naive WLHIV (adjusted Odds Ratio [aOR] =0.83, 95%CI: 0.70-0.99, I2=51%, adjusted for CD4+ count and ART duration), and was also lower among prolonged ART users (>2 years) compared to short-duration users and ART-naïve combined (crude OR=0.65, 95%CI: 0.55-0.77, I2=0.0%). There was some evidence of lower risk of CIN2+/HSIL+ among ART users (aOR=0.65, 95%CI: 0.40-1.06, I2=30%).
Sixteen studies reported the association of ART with longitudinal cervical lesions (SIL) outcomes, from a combined total of 6,664 WLHIV. ART use was associated with a lower risk of any SIL incidence (adjusted Hazard Ratio [aHR] =0.64, 95%CI: 0.47-0.86, I2=19%, adjusted for time-varying ART and CD4+ count), and progression (aHR=0.64, 95%CI: 0.54-0.75, I2=18%) and increased likelihood of SIL regression (aHR=1.58, 95%CI:1.28-1.94, I2=18%).
Prolonged ART use in WLHIV can decrease the risk of HR-HPV and CIN2+/HSIL+ prevalence, SIL incidence and progression and induces regression.