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Review
. 2025 Oct 6.
doi: 10.1007/s10461-025-04835-3. Online ahead of print.

The Impact of Antiretroviral Therapy (ART) on HPV Persistence and Cervical Cancer Progression Among Women with HPV/HIV Co-infection: A Systematic Review

Terkimbi Dominic Swase  1 , Mary Olaoluwa Agunloye  2 , Josiah Eseoghene Ifie  3 , Tijjani Salihu Shinkafi  4 , Joan Chabet  3 , IIemobayo Victor Fasogbon  3 , Solomon Adomi Mbina  3 , Reuben Samson Dangana  5 , Sandra Etumah Ifie  3 , A B Agbaje  6 , Chinyere Anyanwu  6 , Umi Omar Bunu  7 , Angela Mumbua Musyoka  3 , Regan Mujinya  2   8 , Vivian Onyinye Ojiakor  9 , Makena Wusa  9 , Ondari Eric Nyakundi  10 , Patrick Maduabuchi Aja  3
Affiliations
Review

The Impact of Antiretroviral Therapy (ART) on HPV Persistence and Cervical Cancer Progression Among Women with HPV/HIV Co-infection: A Systematic Review

Terkimbi Dominic Swase et al. AIDS Behav. .

Abstract

Cervical cancer remains the leading cause of cancer-related morbidity and mortality among women globally, particularly in low- and middle-income countries. Women living with HIV are at risk of persistent high-risk human papillomavirus (HR-HPV) infections due to HIV-associated immunosuppression. Although antiretroviral therapy (ART) enhances immune function and reduces HIV-related complications, its influence on the persistence of HPV and the progression of cervical cancer remains inconclusive. This systematic review aimed to assess the impact of ART on HPV persistence and cervical cancer progression among HIV-positive women. A comprehensive search of PubMed, Web of Science, and Scopus was conducted for studies published between January 2010 and September 2024. Studies were screened, selected, and reviewed according to PRISMA guidelines using Rayyan. Data on HPV genotypes, ART status, CD4 counts, diagnostic methods, and cervical lesion grades were extracted and analyzed. Eighty studies met the inclusion criteria. HPV16 and HPV18 were the most frequently reported genotypes. Despite ART use, high-grade lesions (CIN II/III and HSIL) remained prevalent, particularly among women with CD4 counts < 350 cells/µL. Diagnostic methods varied, with pap smear and colposcopy most commonly used. ART adherence and duration were associated with improved outcomes, but not complete lesion resolution. ART contributes to immune restoration and may reduce HPV persistence, but does not fully prevent cervical disease progression, mostly in the advanced stage. Integration of regular cervical cancer screening within HIV care is essential to reduce disease burden in this high-risk population.

Keywords: Antiretroviral therapy (ART); Cervical cancer; Cervical intraepithelial neoplasia (CIN); Co-infection; HSIL; Human immunodeficiency virus (HIV); Human papillomavirus (HPV); Immunosuppression.

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Conflict of interest statement

Declarations. Conflict of interest: All the authors declare no competing interest. Ethical Approval: This is a narrative review and does not require ethical approval or consent to participate in the study. Consent for Publication: Not applicable.

References

    1. Ogu CO, Achukwu PU, Nkwo PO. Prevalence and risk factors of cervical dysplasia among human immunodeficiency virus sero-positive females on highly active antiretroviral therapy in Enugu, Southeastern, Nigeria. Asian Pac J Cancer Prev. 2019;20(10):2987–94. https://doi.org/10.31557/APJCP.2019.20.10.2987 . - DOI - PubMed - PMC
    1. Susan CU, Orang’o EO, Liu T, Christoffersen-Deb A, Itsura P, Oguda J, Washington S, Chumba D, Pisharodi L, Rositch AF. Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities. AIDS (London, England). 2017;31(2):233–40. https://doi.org/10.1097/QAD.0000000000001327 . - DOI
    1. Mwakigonja AR, Torres LMM, Mwakyoma HA, Kaaya EE. Cervical cytological changes in HIV-infected patients attending care and treatment clinic at Muhimbili National Hospital Dar es Salaam Tanzania. Infect Agents Cancer. 2012. https://doi.org/10.1186/1750-9378-7-3 . - DOI
    1. Enebe JT, Dim CC, Nnakenyi EF, Ezegwui HU, Ozumba BC. Effect of low CD4 cell count on cervical squamous intraepithelial lesions among HIV-positive women in Enugu, Southeastern Nigeria. J Clin Diagnostic Res: JCDR. 2015;9(11):QC07-QC10. https://doi.org/10.7860/JCDR/2015/14808.6785 . - DOI
    1. Carriero C, Fascilla FD, Cramarossa P, Lepera A, Bettocchi S, Vimercati A. Colpocytological abnormalities in HIV infected and uninfected pregnant women: prevalence, persistence and progression. J Obstet Gynaecol. 2018;38(4):526–31. https://doi.org/10.1080/01443615.2017.1373082 . - DOI - PubMed

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