Prevalence of human papillomavirus infection in Brazilian women living with HIV: a systematic review and meta-analysis

ABSTRACT

Objective

We systematically investigated the prevalence of HPV, high-risk HPV and its genotypes in women living with human immunodeficiency virus (WLHIV) in Brazil.

Methods

A systematic search was performed up to 15 December 2020. We included studies that used molecular methods for HPV detection in cervical samples and reported the prevalence of HPV in Brazilian WLHIV. The pooled prevalence of HPV, high-risk HPV (HR HPV) and HPV types and their 95% confidence interval (CI) were estimated. Subgroup analyses and meta-regression were conducted.

Results

Thity-seven studies accounting for 8,436 WLHIV were included. The pooled HPV prevalence was 62% (95%CI 55–68%; I² = 96.98%; P < 0.001). Prevalence of high-risk HPV was 40% (95%CI, 54–68%; I² = 94.23%; P < 0.001). We found a wide variety of high-risk HPV genotypes. The high-risk HPV types most reported were HPV 16 (16%) and HPV 58 (6%). We found an increasing ratio of positivity from normal cervix to cancer. There were different factors associated with high-risk HPV, with low CD4+ count the most frequent.

Conclusion

The increase in the ratio of high-risk HPV positivity from normal cervix to carcinogenic lesions highlights the need to implement well-established testing for high-risk HPV in this population.

KEYWORDS:

• Human papillomavirus
• human immunodeficiency virus
• women living with human immunodeficiency virus
• systematic review
• meta-analysis
• prevalence
• Brazil

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

Concept and design: B. E. B. da SILVA, L. M. D. de LEMOS and V. S. SANTOS. Acquisition of data: B. E. B. da SILVA, L. M. D. de LEMOS, M. V. de A. BATISTA, C. A. LIMA and V. S. SANTOS.

Statistical analysis and interpretation of data: B. E. B. da SILVA, P.R. MARTINS-FILHO and V. S. SANTOS. Drafting of the manuscript: B. E. B. da SILVA and V. S. SANTOS. All authors contributed equally to data interpretation, critically reviewed the manuscript and approved the final version. B. E. B. da SILVA and V. S. SANTOS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This manuscript was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.