Abstract
Evaluation of: Minkoff H, Xian LS, Watts HD et al. Relationship of pregnancy to human papillomavirus among human immunodeficiency virus-infected women. Obstet. Gynecol. 108[4], 953–960 [2006].
The relationships that exist between human papillomavirus (HPV) infection and pregnancy remain controversial and have rarely been properly investigated in the context of HIV infection. The paper under discussion presents important data on the effect of pregnancy on the natural history of HPV infection obtained from two US cohorts of HIV-infected women, who were either pregnant at enrollment or became pregnant during follow-up. The results indicate that cervical HPV prevalence and HPV DNA viral loads are not increased during pregnancy in HIV-infected women and that incident HPV detection is significantly lower during pregnancy when compared with the postpregnancy period. These results suggest that the immune suppression and changes in vaginal milieu associated with pregnancy are of little importance compared with immune suppression due to HIV for HPV acquisition. Although these findings are reassuring regarding the effect of pregnancy per se, they also point to the lack of information on the risk and cofactors that govern HPV acquisition and persistence and premalignant lesion development during the postpartum period, which would appear of greater public health relevance. The introduction of HPV vaccines should curb the risk of high-risk HPV infection in childbearing-age women in the future but protection will be incomplete and will depend on coverage in different populations. The introduction of more systematic screening based on cervical cytology in combination with HPV testing could also improve the management of HIV-infected women.