Highlights
- •Progression of cervical lesions was lower and regression higher in women on HAART compared to those not on therapy.
- •Clearance of HPV infection was higher in women on HAART therapy.
- •HAART should be offered to all WLHIV, even in resource-constrained countries.
Abstract
Background
Collating evidence on the impact of highly active antiretroviral therapy (HAART) on
the outcome of cervical lesions or human papillomavirus (HPV) infection among women
living with HIV (WLHIV) is essential to inform cervical cancer prevention in this
vulnerable group.
Methods
We performed a systematic review and meta-analysis of cohort studies that were conducted
between January 1, 1996 and January 31, 2022 and reported on the association of HAART
with any of the outcomes: incidence, progression, or regression of cervical lesions
or acquisition or clearance of HPV infection in WLHIV. Random-effect analysis was
used for summary statistics and heterogeneity was assessed through I2 statistic. The protocol for this review has been registered on the PROSPERO database
with registration number CRD42021285403.
Results
Among 11 studies, the summary estimate of incident cervical lesions was lower in WLHIV
on HAART (0.81, 95% CI 0.60–1.08). HAART was associated with lower risk of cervical
lesion progression (0.76, 95% CI 0.64–0.92, I2 55.6%) and higher regression rate of these lesions (1.43, 95% CI 1.06–1.94, I2 81%). Though HPV acquisition was not significantly lower in HAART users (0.83, 95%
CI 0.40–1.70), the clearance of HPV infection was higher in WLHIV on HAART (1.41,
95% CI 1.14–1.76, I2 2.4%).
Conclusion
This review provides evidence that HAART assists in reducing the incidence and progression
of cervical lesions and enhancing their regression in women living with HIV. Hence,
the HAART regime should be recommended to all WLHIV with advice for adherence to allow
for early immune reconstitution.
Keywords
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Article info
Publication history
Published online: September 29, 2022
Accepted:
September 26,
2022
Received in revised form:
September 23,
2022
Received:
June 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
