Relationship between Highly Active Antiretroviral Therapy (HAART) and human papillomavirus type 16 (HPV 16) infection among women in Sub-Saharan Africa and public health implications: A systematic review

PLoS One. 2019 Mar 11;14(3):e0213086. doi: 10.1371/journal.pone.0213086. eCollection 2019.

Abstract

Invasive cervical cancer is the most prevalent cancer among women in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) emitted recommendations to start Highly Active Antiretroviral Therapy (HAART) regardless of CD4 count. Although HAART has been shown to reduce the prevalence of high-risk human papillomavirus (HR-HPV) genotypes, it is unclear whether it confers a protective effect specifically for HPV 16. This review summarizes the existing evidence regarding the effect of HAART on HPV 16 infection, as this genotype may not be influenced by immunity level and explores its implications for Sub Saharan Africa. A comprehensive literature review was undertaken and quality assessment was carried out on the selected papers. Four cohort studies and three cross-sectional studies were identified for which the overall quality score assessment ranged from weak/moderate (Score of 1.8) to strong (Score of 3). The evidence yielded by our review was conflicting. Thus, the high heterogeneity between study populations and results did not allow us to draw any firm conclusions as to whether HAART has an impact on HPV 16 acquisition/prevalence. As only three studies were conducted in Africa, there are insufficient grounds for solid comparison between geographic regions. In light of inadequate data, HPV unvaccinated women on HAART should still receive more frequent follow-up.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Africa South of the Sahara / epidemiology
  • Anti-Retroviral Agents / pharmacology*
  • Anti-Retroviral Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods*
  • Cross-Sectional Studies
  • Female
  • Human papillomavirus 16 / drug effects*
  • Human papillomavirus 16 / pathogenicity
  • Humans
  • Middle Aged
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / prevention & control
  • Prevalence
  • Public Health
  • Qualitative Research
  • Uterine Cervical Neoplasms / drug therapy*
  • Uterine Cervical Neoplasms / virology

Substances

  • Anti-Retroviral Agents

Grants and funding

The authors received no specific funding for this work.