"High prevalence of HPV was documented in pregnant WLWH [women living with HIV], exceeding the prevalence among pregnant women without HIV," Elisabeth McClymont, PhD, of the University of British Columbia in Vancouver, Canada, and her colleagues write in Journal of Acquired Immune Deficiency Syndrome.
"Our findings of a high prevalence of HPV infection during pregnancy in WLWH, particularly of highly oncogenic HPV types, emphasize the need for HPV screening and vaccination in WLWH," they add. "WLWH are a key population for both HPV and adverse pregnancy outcome prevention."
Emerging evidence suggests that being infected with HPV during pregnancy may be linked with adverse pregnancy outcomes. Although women living with HIV have higher rates of HPV infection and adverse pregnancy outcomes, no prior reviews have reported on HPV infection during pregnancy in women living with HIV, the authors explain.
A Study of Studies
McClymont and her colleagues searched the standard medical research databases through January 18, 2022, for pooled and type-specific HPV prevalence and associated pregnancy outcomes among pregnant women living with HIV, including available within-study comparators of women without HIV.
They performed subgroup analyses according to polymerase chain reaction primers used to detect HPV type and according to region (Africa; Asia and Europe; the Americas).
Their analysis of ten studies describing HPV prevalence in 1594 pregnant women living with HIV found:
The pooled HPV prevalence in pregnant women living with HIV was 75.5% (95% CI, 50.2-90.4) but ranged from 23% to 98% between individual studies.
Among the five studies that also analyzed HPV prevalence in pregnant women without HIV, the pooled prevalence was 48.1% (95% CI, 27.1-69.8).
Pregnant women living with HIV had 54% higher odds of being HPV positive than did pregnant women without HIV.
HPV16 was the most common HPV type detected in pregnant women living with HIV, followed by HPV52; other common types included HPV18 and HPV58.
One study provided data on pregnancy outcomes in women living with HIV but did not correlate pregnancy outcomes with HPV status.
Experts Urge HPV, Cervical Cancer Screening for Women Living With HIV
"HPV is a common virus that can lead to cervical dysplasia and cervical cancer," Clara Paik, MD, professor and clinic medical director of obstetrics and gynecology at UC Davis Health in Sacramento, California, cautioned.
"HPV can also be associated with adverse pregnancy outcomes, including preterm birth and premature membrane rupture," she told Medscape Medical News. "It is important to know the prevalence of HPV infection in pregnant women living with HIV in order to assess if this specific population is at higher risk for adverse pregnancy outcomes."
Paik, who was not involved in the study, would like these results to lead to better HPV screening in pregnant women living with HIV.
"The study's strengths include the large number of women studied when all the research studies were pooled," she said. "A weakness is that, if individual studies had limitations, a systematic review based on weaker studies may not necessarily yield results that are conclusive."
Linda Eckert, MD, professor of obstetrics and gynecology at the University of Washington School of Medicine in Seattle, said that the study highlights the importance of including cervical cancer screening in antepartum care, especially in areas of high HIV prevalence.
"Women living with HIV have a 6-fold increased rate of developing cervical cancer compared to women without HIV," she added, citing a 2020 analysis in The Lancet Global Health that estimated global cervical cancer risk among women living with HIV.
"This [new] study allows us to definitively say that pregnant women living with HIV have higher rates of HPV than do pregnant women without HIV," noted Eckert, who was not involved in either study. "And HPV type 16 — the HPV type most associated with developing cervical cancer — was the most common high-risk HPV type found in these patients."
HPV Vaccination Recommended
The World Health Organization's (WHO's) call to eliminate cervical cancer has generated interest and funding for cervical cancer screening of women with HIV, she said. "WHO recommends that women living with HIV who are 25 years of age and above be screened for cervical cancer annually."
The authors urge that women living with HIV not only be screened for HPV but that they also be vaccinated against HPV.
"We know that HPV vaccination is unprecedented in its ability to prevent HPV infections when it is received prior to acquiring HPV infection," Eckert said, "but currently data showing that HPV vaccination would treat HPV16 in pregnant women already infected with HPV16 are lacking."
"This study points to the need for a trial to investigate HPV vaccination in pregnant women living with HIV who have the high-risk HPV types," she suggested.
Eckert contributed to the American College of Obstetricians and Gynecologists' 2020 Human Papillomavirus Vaccination Committee Opinion.
One author reports financial relationships with Merck. McClymont, the other co-authors, as well as Paik and Eckert report no relevant financial relationships. All experts commented by email.
Source: J Acquir Immune Defic Syndr. Published online October 1, 2022. Abstract
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Cite this: HPV Infection in Pregnancy Higher Among Women Living With HIV - Medscape - Oct 06, 2022.