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

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.