High-risk human papillomavirus infection among women living with HIV in Latin America and the Caribbean: A systematic review and meta-analysis.

ABSTRACT

We carried out a systematic review to summarize available data regarding prevalence of high-risk human papillomavirus (HR-HPV) among women living with HIV (WLHIV) in Latin America and the Caribbean (LAC). A literature search in PubMed and LILACS was conducted and supplemented with cross-referencing and grey literature. The primary outcome was prevalence of HR-HPV by age as a major determinant of HPV infection. Pooled prevalence and weighted averages were obtained. A random effects meta-analysis conducted for HPV- and HIV-associated factors. In total, 6157 women from 19 cross-sectional studies were included. Weighted prevalence of HR-HPV in WLHIV was 51.0% (95% CI 42.8-59.1, I2 = 97.4%) with a bimodal trend by age. No association between antiretroviral therapy and HR-HPV prevalence was observed, but low CD4 cell count was associated (PR 1.64, 95% CI 1.07-2.52). Although not significant, a higher HR-HPV prevalence was observed with Hybrid Capture 2 versus PCR. The high prevalence of HR-HPV among WLHIV in LAC underlines the need for improved cervical cancer prevention and early detection in this vulnerable population. Moreover, the high prevalence across age groups, and particularly in young women, deserves careful consideration for defining target populations of HPV-based screening and HPV immunization programs.