Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort

Sexual risk behaviors among HIV-infected South African men and women with their partners in a primary care program: implications for couples-based prevention

We studied 1163 sexually-active HIV-infected South African men and women in an urban primary care program to understand patterns of sexual behaviors and whether these behaviors differed by partner HIV status. Overall, 40% reported a HIV-positive partner and 60% a HIV-negative or status unknown partner; and 17.5% reported >2 sex acts in the last 2 weeks, 16.4% unprotected sex in the last 6 months, and 3.7% >1 sex partner in the last 6 months. Antiretroviral therapy (ART) was consistently associated with decreased sexual risk behaviors, as well as with reporting a HIV-negative or status unknown partner. The odds of sexual risk behaviors differed by sex; and were generally higher among participants reporting a HIV-positive partner, but continued among those with a HIV-negative or status unknown partner. These data support ART as a means of HIV prevention. Engaging in sexual risk behaviors primarily with HIV-positive partners was not widely practiced in this setting, emphasizing the need for couples-based prevention.

Human papillomavirus, cancer and vaccination

PURPOSE OF REVIEW

HIV-positive men and women are at greater risk of human papillomavirus (HPV)-related cancers compared with the general population. This study describes recent findings in HPV-related cancers and precancerous lesions and discuss the potential benefit of recently developed prophylactic HPV vaccines.

RECENT FINDINGS

Despite improving access to antiretroviral therapy (ART), particularly in developing countries, the incidence of cervical cancer has not declined and the incidence of anal cancer is still rising in HIV-infected individuals. HIV appears to affect the history of HPV infection, and the distribution of genotypes detected in precancerous lesions in HIV-infected women is not similar to that of the general population. The use of the quadrivalent HPV vaccine has been shown to prevent cervical precursor lesions caused by the vaccine types in women in the general population. Safety and immunogenicity studies of the quadrivalent HPV vaccine in HIV-infected individuals are underway. Efficacy has to be proven in the context of both a different epidemiology of HPV infection and of immunosuppression.

SUMMARY

Recent data imply that the issue of HPV-related cancers will not decline in HIV-infected individuals. Therefore, efficacy studies of HPV vaccines are sorely needed in the setting of HIV.

See-and-treat approaches to cervical cancer prevention for HIV-infected women

Cervical cancer remains the second commonest cancer among women worldwide, and more than 85% of the global burden of this disease occurs in the developing world. HIV-infected women have a higher likelihood of developing persistent high-risk human papillomavirus (HPV) infection, precancer, and invasive cervical cancer than seronegative women. Although highly effective primary and secondary prevention strategies are currently available, they remain inaccessible to the vast majority of women. Because of their simplicity and affordability, see-and-treat cervical cancer screening modalities have the potential to substantially improve women's access to cancer prevention, as well as to create much needed infrastructure for future molecular-based cervical screening and HPV vaccination programs. Additional data addressing the effectiveness of see-and-treat approaches for HIV-infected women are urgently needed. Studies informing best practice guidelines on when to start, when to stop, and how frequently to screen HIV-infected women within the see-and-treat paradigm would be of great value.

Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics

OBJECTIVE

In light of increasing access to HAART in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics.

DESIGN

Prospective observational cohort.

METHODS

We conducted a cohort study at rural and urban primary care HIV clinics in South Africa consisting of 1544 men and 4719 women enrolled from 2003 to 2010, representing 19703 clinic visits. The primary outcomes were being sexually active, unprotected sex, and more than one sex partner and were evaluated at 6 monthly intervals. Generalized estimated equations assessed the impact of HAART on sexual risk behaviors.

RESULTS

Among 6263 HIV-infected men and women, over a third (37.2%) initiated HAART during study follow-up. In comparison to pre-HAART follow-up, visits while receiving HAART were associated with a decrease in those reporting being sexually active [adjusted odds ratio: 0.86 (95% confidence interval: 0.78-0.95)]. Unprotected sex and having more than one sex partner were reduced at visits following HAART initiation compared to pre-HAART visits [adjusted odds ratio: 0.40 (95% confidence interval: 0.34-0.46) and adjusted odds ratio: 0.20 (95% confidence interval: 0.14-0.29), respectively].

CONCLUSION

Sexual risk behavior significantly decreased following HAART initiation among HIV-infected South African men and women in primary care programs. The further expansion of antiretroviral treatment programs could enhance HIV prevention efforts in Africa.