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HAART Adherence And Efficacy May Affect HPV Infection Rates And Cervical Lesion Clearance In HIV-Positive Women

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Published: Feb 24, 2011 4:50 pm
HAART Adherence And Efficacy May Affect HPV Infection Rates And Cervical Lesion Clearance In HIV-Positive Women

Results of a recent study suggest that women who adhere to their antiretroviral regimens or have effective antiretroviral treatment regimens have lower rates of human papillomavirus infection and faster clearance of pre-cancerous cervical lesions.

The results may explain why age-specific cervical cancer rates among HIV-positive women have not increased with the rise of highly active antiretroviral therapy (HAART) even though women with HIV are living longer. However, the researchers stated that they still expect the overall rates of cervical cancer in the HIV-positive population to increase since older women have higher rates of cervical cancer.

The authors also suggested that conflicting findings in previous studies of HAART, human papillomavirus (HPV), and cervical lesions may be due to differences in patient adherence or effectiveness of HAART regimens.

HPV is one of the most common sexually transmitted diseases. Around 75 percent to 80 percent of women with HIV also have HPV. Women with HIV have a weakened immune system, which allows HPV to survive in the cervix and cause pre-cancerous lesions. As a result, cervical cancer caused by HPV is especially common in HIV-positive women.

Studies on the effects of HAART on HPV and cervical cancer have shown mixed results. Since HAART allows women with HIV to live longer, it raises the likelihood of exposure to HPV and also allows for longer HPV persistence and the accumulation of mutations that lead to cervical cancer. Moreover, as HIV-positive women live longer, they enter the age groups in which cervical cancer rates are greatest.

HAART can, however, restore the functioning of the immune system. An effective immune system is strongly linked with prevention of new strains of HPV, shorter HPV infections, and less pre-cervical cancer in women with HIV.

In this study, researchers investigated whether rates of HPV infection and pre-cervical cancer are related to patient adherence to their HAART regimen and the efficacy of HAART in suppressing HIV.

The study included 286 HIV-positive women starting HAART for the first time. The researchers measured rates of HPV infection and pre-cervical cancer before and after HAART initiation. They also measured the adherence of the study participants to their antiretroviral regimens and their viral loads (amount of HIV in the blood).

Adherent women were defined as those who took their medications as prescribed at least 95 percent of the time; the rest were considered non-adherent. HAART was considered effective if a woman’s viral load was reduced by more than 90 percent or to undetectable levels.

Results showed that after starting HAART, the number of women who tested positive for HPV strains known to cause cervical cancer decreased by 36 percent among adherent women, compared to 12 percent among non-adherent women.

In addition, the number of women who tested positive for cancer-causing HPV decreased 20 percent in patients on effective HAART, but increased slightly for those on ineffective HAART.

Women adherent to HAART were less likely to contract new cancer-causing HPV strains. The rate of detection of new HPV strains decreased 33 percent for adherent women versus 9 percent in non-adherent women.

Results revealed that adherent and non-adherent women had a similar decrease in the rate of development of pre-cancerous cervical lesions. However, women adherent to HAART had higher clearance rates for lesions than women who were non-adherent.

Similarly, the effectiveness of HAART did not affect the number of pre-cancerous lesions developed, but effective HAART was associated with greater lesion clearance rates compared to before the women started treatment while ineffective HAART was not.

The researchers acknowledged several limitations of the study, including the fact that it is not possible to be completely certain how the data relate to actual cervical cancer rates since the study only considered the development of HPV and pre-cervical cancer. The researchers recommended longer-term follow up studies to examine rates of cervical cancer.

For more information, please see the study in The Journal of Infectious Diseases.

Photo by Wesley Carter of the U.S. Air Force on Wikipedia - this image is in the public domain.
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