HIV acquisition may be enhanced by HPV infection through genital inflammatory pathways HIV risk
Young women in sub-Saharan Africa have a high burden of human papillomaviruses (HPV) infection, a virus associated with cervical cancer. The behavioural risks of HPV infection are also risk factors for human immunodeficiency virus (HIV). HPV has been found to be associated with an increased risk of HIV acquisition, but it was unclear whether this is due to behaviours that lead to both HPV and HIV or whether it is due to a shared biological mechanism.
To better understand the underlying biological mechanisms for this association, HPV infection and cytokine biomarkers of genital inflammation were assessed in women at high risk of HIV infection (CAPRISA 004 trial; N=779).
The study, published in the journal Nature Communications, observed a high prevalence of HPV in the population (74%) and showed an epidemiological link between HPV status (prevalence, clearance, persistence, acquisition, multiple concurrent HPV infection, or infection with oncogenic or vaccine-type HPV) and increased risk of HIV acquisition (Figure).
Female genital tract cytokines associated with HPV infection status were distinct from those observed in HPV negative women, and overlapped substantially with cytokines associated with HIV risk; indicating that immune responses directed at clearing or controlling HPV infection may inadvertently promote susceptibility to HIV infection.
The data show a relationship between the acquisition or clearance of any one sub-type of HPV and subsequent HIV acquisition with an indication that inflammatory cytokines may be a mechanism by which the two infections have an epidemiological association. The findings also point to the potential impact of HPV vaccination on HIV acquisition, if this relationship is causal. It highlights the importance of HPV vaccination and of understanding the immune impact of HPV infection in vaccinated individuals and its relation to HIV risk.
Overall, the data suggest that in addition to preventing cervical cancer, HPV prevention may have an impact on HIV acquisition. More effective ways to prevent and/or treat HPV infection or modify its immunological effects, could have potential HIV prevention benefits.
For further reading:
Liebenberg, L.J.P., McKinnon, L.R., Yende-Zuma, N. et al. HPV infection and the genital cytokine milieu in women at high risk of HIV acquisition. Nat Commun (2019) doi:10.1038/s41467-019-13089-2