Abstract Background Whilst HIV/HPV co-infection significantly increases cervical carcinogenesis, the relationship with HPV-related non-cervical cancers is less understood. HPV vaccination is key in prevention, but global coverage is low (21%). We aimed to quantify the risk of non-cervical cancers amongst people living with HIV and AIDs (PWHA), estimate this cancer burden globally, and the impact of improved HPV vaccine coverage. Methods We conducted a systematic review and meta-analysis of three databases to identify studies comparing HPV-related non-cervical cancer risk in PWHA and HIV negative populations, generating a risk ratio for each cancer. This was combined with country-specific HIV prevalence and the incidence of cancer cases to calculate the burden. Vaccine impact was estimated using vaccine coverage data and point efficacy estimates. Results 25 studies were included analysing 1,560,923 million PWHA. The risk of developing each HPV-related non-cervical cancer was significantly increased in PWHA. The pooled risk was 30.32 (CI 20.54-44.75) for anal, 15.78 (CI 4.62-53.92) for vaginal, 6.99 (CI 3.37-14.51) for vulvar, 6.37 (CI 3.98-10.21) for penile and 2.74 (CI 2.10-3.58) for oropharyngeal cancers. Globally, 30% of cases in Africa were HIV-attributable, compared to 5% worldwide. If HPV vaccination coverage increased to 90%, we could prevent 1987 more cancer cases, assuming 50% vaccine efficacy. Conclusions This meta-analysis confirms that PWHA are more susceptible to adverse outcomes beyond cervical cancer and must be prioritised in HPV prevention and vaccine efficacy research. In countries with high HIV/HPV coinfection prevalence, integrating HPV vaccination with HIV services could minimise disparities in the cancer burden worldwide.
Wongkalasin et al. (Tue,) studied this question.
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