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Evidence of synergistic relationships between HIV and human papillomavirus (HPV): Systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status

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Title: Evidence of synergistic relationships between HIV and human papillomavirus (HPV): Systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status
Authors: Looker, K
Ronn, M
Brock, P
Brisson, M
Drolet, M
Mayaud, P
Boily, MC
Item Type: Journal Article
Abstract: Introduction: Observational studies suggest HIV and human papillomavirus (HPV) infections may have multiple interactions. We reviewed the strength of the evidence for the influence of HIV on HPV acquisition and clearance, and the influence of HPV on HIV acquisition. Methods: We performed meta-analytic systematic reviews of longitudinal studies of HPV incidence and clearance rate by HIV status (review 1) and of HIV incidence by HPV status (review 2). We pooled relative risk (RR) estimates across studies using random-effect models. I 2 statistics and subgroup analyses were used to quantify heterogeneity across estimates and explore the influence of participant and study characteristics including study quality. Publication bias was examined quantitatively with funnel plots and subgroup analysis, as well as qualitatively. Results and discussion: In review 1, 37 publications (25 independent studies) were included in the meta-analysis. HPV incidence (pooled RR=1.55, 95%CI 1.29-1.88; heterosexual males: pooled RR=1.95, 95%CI 1.62, 2.34; females: pooled RR=1.63, 95%CI 1.26-2.11; men who have sex with men: pooled RR=1.36, 95%CI 1.01-1.82) and high-risk HPV incidence (pooled RR=2.20, 95%CI 1.90-2.54) was approximately doubled among people living with HIV (PLHIV) whereas HPV clearance rate (pooled RR=0.53, 95%CI 0.42-0.67) was approximately halved. In review 2, 14 publications (11 independent studies) were included in the meta-analysis. HIV incidence was almost doubled (pooled RR=1.91, 95%CI 1.38-2.65) in the presence of prevalent HPV infection. There was more evidence of publication bias in review 2, and somewhat greater risk of confounding in studies included in review 1. There was some evidence that adjustment for key confounders strengthened the associations for review 2. Misclassification bias by HIV/HPV exposure status could also have biased estimates toward the null. Conclusions: These results provide evidence for synergistic HIV and HPV interactions of clinical and public health relevance. HPV vaccination may directly benefit PLHIV, and help control both HPV and HIV at the population level in high prevalence settings. Our estimates of association are useful for mathematical modelling. Although observational studies can never perfectly control for residual confounding, the evidence presented here lends further support for the presence of biological interactions between HIV and HPV that have a strong plausibility.
Issue Date: 1-Jun-2018
Date of Acceptance: 27-Mar-2018
URI: http://hdl.handle.net/10044/1/58624
DOI: https://dx.doi.org/10.1002/jia2.25110
ISSN: 1758-2652
Publisher: International AIDS Society
Journal / Book Title: Journal of the International AIDS Society
Volume: 21
Issue: 6
Copyright Statement: © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, pro vided the original work is properly cited.
Sponsor/Funder: Commission of the European Communities
National Institutes of Health
MRC
Funder's Grant Number: 242061
UM1AI068617 Sub#0000925919
MR/M01231X/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
HPV
HIV
sexually transmitted infections
epidemiology
incidence
meta-analysis
systematic review
humans
HUMAN-IMMUNODEFICIENCY-VIRUS
ANAL HUMAN-PAPILLOMAVIRUS
CERVICAL HUMAN-PAPILLOMAVIRUS
ACTIVE ANTIRETROVIRAL THERAPY
SEXUALLY-TRANSMITTED INFECTIONS
PROSPECTIVE FOLLOW-UP
HIGH-RISK WOMEN
NATURAL-HISTORY
NEGATIVE WOMEN
POSITIVE WOMEN
1199 Other Medical And Health Sciences
Publication Status: Published
Article Number: e25110
Online Publication Date: 2018-06-05
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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