Understanding the Impact of Antiretroviral Therapy and Other Factors on HPV Clearance in Cisgender Women with HIV/HPV Co-infections in the DC Cohort.

Background: Women with HIV are at an elevated risk for HPV. Antiretroviral therapy (ART) effectively treats HIV; however, there is no non-invasive pharmacological treatment for HPV. Previous studies have shown varied effects of ART class on HPV clearance, with some demonstrating an association. Our objective was to evaluate the association between ART class and HPV clearance among women with HIV/HPV co-infections.

Methods: We analyzed electronic health records from participants with HPV in the DC Cohort Longitudinal HIV Study from time at HPV detection to January 1, 2024. We investigated time to HPV clearance based on time-updated ART status using Cox proportional hazards and Kaplan Meier models, focusing on protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs).

Results: Among 362 women with HIV/HPV co-infections, 94.8% were Non-Hispanic Black, 81.2% had public insurance, and 45.6% were smokers. Overall, 74.0% cleared their HPV infection. A higher proportion of participants who cleared HPV were on PIs at baseline compared to those who did not (p=0.03). Those who did not achieve clearance had lower nadir CD4 counts (p=0.04) and did not achieve viral suppression (p=0.0005). In the survival analysis, women on PI-based regimens had shorter time to HPV clearance compared to those on INSTIs (HR = 2.12, 95% CI: 1.39, 3.24).

Conclusion: This study suggests that PIs may be associated with a higher likelihood of HPV clearance among women with HIV. Our results provide evidence on the influence of clinical and sociodemographic factors, including ART, that may affect HPV clearance among women with HIV.