The Impact of the Human Immunodeficiency Virus on the Human Papillomavirus Epidemic

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Abstract
Objective: To examine how human immunodeficiency virus (HIV) infections affect human papillomavirus (HPV) infections. Data Source: MEDLINE was searched for relevant publications. Study Selection: All studies dealing with both HIV and HPV infections were reviewed. Data Extraction: Publications with clinically relevant data were included in the present analysis. Data Synthesis: A critical analysis of the data described in these articles was performed without formal statistical calculations. Conclusions: Results revealed that immunocompromised individuals have an increase prevalence of HPV-associated lesions and neoplasia. Immunosuppressed patients (eg, those who have undergone transplantation or those who have been treated with chemotherapy and/or radiation therapy) have a higher rate of HPV infections. Human papillomavirus and HIV appear to be important cofactors for developing cervical and anal dysplasia and carcinoma. Individuals who are seropositive for HIV have an increased prevalence of HPV infections, a more rapid progression of the disease, and a higher number of invasive carcinomas. The presence of HPV DNA, extent of disease, and potential for malignant transformation also appear to correlate with the degree of immunosuppression. Individuals with a CD4 cell count under 0.20×109/L (<200/μL) are at greatest risk. Treatment options for immunocompromised individuals remain similar to those for normal hosts; however, immunocompromised individuals have a much higher rate of recurrence. Improved immunostimulant and/or antiviral therapy is needed for HIV-seropositive individuals with wide-spread genital involvement. Control of both the HPV and the HIV epidemics involves at least 3 levels of intervention: better antiviral drugs, frequent monitoring for disease progression in infected persons, and better education to reduce spread of the disease. Arch Dermatol. 1997;133:629-633

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