The impact of HPV/HIV co-infection on immunosuppression, HPV genotype, and cervical cancer biomarkers

Abstract

Human papillomavirus (HPV) and human immunodeficiency virus (HIV) co-infection present a significant impact on women's health globally, especially in immunocompromised individuals. HIV-induced immunosuppression promotes the persistence of high-risk HPV infection and increased the progression to cervical cancer. The aim of this systematic review was to assessed the impact of HPV/HIV co-infection on the prevalence and distribution of HR-HPV genotypes, the level of immunosuppression and expression of cervical cancer biomarkers. The article selection method for this review was based on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The total of eighty-four (84) articles from standard electronic databases mainly Web of Science, PubMed, and Scopus were extracted and reviewed. The articles were published in English between 2008 and 2024 and comprised a total of 80023 participants. The HR-HPV genotypes reported across various studies include HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, and 82. Among HIV positive individuals, the most common circulating HR-HPV genotypes were HPV16, 18, 45, 35, and 58, accounted for 11%, 10%, 9%, 8%, and 8% of cases, respectively. Approximately 29.1% and 30.0% of patients had CD4 counts of 200–400 cells/L and 300–400 cells/L, respectively. The most commonly reported cervical cancer biomarkers were p16INK4a and Ki-67, according to the analysis. The findings indicate high prevalence of multiple HR-HPV genotypes among HIV positive individuals, indicating the impact of HPV/HIV co-infection on immunosuppression and persistence of HPV infection. The expression of cervical cancer biomarker such as p16INK4a and Ki-67 emphasized target screening and early detection strategy in high-risk population. However, there was no direct impact of HPV/HIV co-infection reported on these biomarkers and required to be studied more especially in people living with HIV. ◦ An analysis revealed a significant occurrence of high-risk HPV genotypes, namely HPV16, 18, and 45, among women who had HIV. ◦ In comparison to HIV-negative women, HIV-positive women had a higher probability of experiencing persistent HPV infections and more severe cervical lesions. ◦ Significant correlations were seen between CD4 levels and the occurrence of high-risk HPV infections, suggesting the involvement of immunosuppression in the persistence of HPV. ◦ Cervical cancer biomarkers reported across various studies were p16INK4a and Ki-67, despite these biomarkers reported there was no established direct impact of HPV/HIV co-infection to indicate aggressive disease development. ◦ The results suggest the need for implementation of focused screening and vaccination programs for cervical cancer in populations at high risk, particularly among women who are HIV-positive.