Human Papillomavirus Infection and Anogenital Neoplasia in Human Immunodeficiency Virus-Positive Men and Women

Human immunodeficiency virus (HIV)-positive women have a higher prevalence of human papillomavirus (HPV) infection in the cervix and anus, as well as squamous intraepithelial lesions (SILs) at these sites, than do HIV-negative women matched for age and HIV risk factors. Similarly, HIV-positive homosexual or bisexual men have a higher prevalence of anal HPV infection and anal SIL than do HIV-negative homosexual or bisexual men. In HIV-positive individuals, the prevalence of HPV infection, the proportion infected with multiple HPV types, and the prevalence of anogenital SILs increase with decreasing CD4 count. This situation may reflect loss of systemic immune response to HPV antigens or local HPV-HIV interactions at the tissue or cellular level. Despite the high levels of anogenital SILs, to date, there has not been a significant increase in reported cases of invasive anogenital cancer in HIV-positive individuals. However, several years may be required for SIL to progress to invasive cancer, and the advent of newer therapies for HIV that are expected to prolong survival may paradoxically increase the risk of progression to cancer in individuals with SILs if these lesions do not regress spontaneously and remain untreated.