HIV and HPV: Are they the same or different?

HPV

Human papillomavirus (HPV) is a common type of sexually transmitted disease (STD) that can be passed on through skin-to-skin exposure. One can be asymptomatic yet a carrier of HPV and transmit the disease to their sexual partner without realising.

There are over 150 subtypes of HPV viruses in the world. We can broadly classify HPV into 2 main groups:

• Low risk HPV: HPV viruses that is associated with warts- cauliflower stuck on lesions/ growth that can be found over the genital region (vulvovaginal, penis, anus) and mouth cavity.
• High risk HPV: HPV viruses that is associated with pre-cancerous and invasive cancerous findings over the cervix, vagina, vulva, penis, anus or even the mouth/throat region.

HIV

The human immunodeficiency virus (HIV) diminishes the immune system by killing and destroying a type of immune cell known as CD4 T-lymphocytes. These cells are important to protect the body against various infections. Over time, with HIV infection progresses, there is progressive loss of CD4 cells, leading to a detrimental drop in general immune system, and increased risk of opportunistic infections (infections that do not occur in a healthy immune system). Over time, one can progress into an advanced stage of HIV infection known as AIDS- acquired immunodeficiency syndrome.

While currently there remains no cure to HIV infection, medical advancement is promising with effective antiretroviral therapy (ART) to control HIV. HIV medicine allows one with HIV to be able to enjoy a good quality of life and have a similar life span with those without HIV. With proper ART use, and if the HIV viral load is kept undetectable (the lowest possible level), the risk of HIV transmission can be reduced.

How can we contract HPV?

HPV infection is contracted through sexual intercourse, and as mentioned previously, one can be asymptomatic yet is a carrier of the virus, spreading to sexual partner(s). Worse still, HPV can live in the body for years without showing any abnormal symptoms.

What is the connection between HPV and HIV?

HIV can lower a person’s immune system, increase the risk of infection with HPV and reduce the ability to clear off HPV infection, leading to a higher risk of developing HPV-related invasive cancer. There is also impaired immune response to HPV in those having HIV, and direct interaction between the 2 viruses.

Those with HIV have a higher risk of developing warts in the genital and oral areas.

Both female and male with HIV infection are at higher chance of contracting HPV-related cancers including cervical cancer (female only), 80-90% of anal cancer (female and male), oral cancer (female and male), vaginal/vulva cancer (female) and penile cancer (male).

In HIV positive female patients who have HPV co-infection, the risk of developing precancerous HPV infection, invasive cervical cancer is higher and faster.

HIV medication (ART) is clinically effective in maintaining good CD4+ count and immune system, lowers the risk of acquiring HPV, aids clearance of HPV, reduce risk of progression to precancerous or invasive state of HPV.

Can I test for HPV?

HPV testing is currently recommended for women as part of cervical cancer screening. The HPV test is able to detect high-risk types of HPV that can cause pre-cancerous or invasive cancerous changes of the cervix.

Unfortunately, in men, there is no FDA-approved or recommended HPV test available.

How can I reduce my risk of acquiring HPV?

HPV vaccine can reduce a person’s risk of contracting HPV infection, minimising risk of developing warts, HPV related precancerous and cancer lesions.

While HPV vaccination is most useful when given to a person before becoming sexually active/ exposed to virus, it is still of benefit to be given to a person who is already sexually active/potentially exposed to the virus. Currently HPV covalent-9 vaccine is offered from the age 9 years old to 45 years old. Adult is recommended for 3 doses of the HPV covalent-9 vaccine over the course of 6 months.

Limiting the number of sexual partner(s) or avoiding partner(s) who has multiple partner(s) can reduce a person’s risk against HPV. While condom is not full proof either, using it correctly every time during intercourse can minimise the risk of STD, including HPV infections.

What is the treatment for HPV, if I also have HIV?

• In HPV-related warts, one can consider treatment options ranging from topical imiquimod, salicylic acid, to cryotherapy, electrocautery, or even surgical excision.
• In those who present with HPV-related precancerous changes, the lesions will need to be removed via cryotherapy, laser or surgically depending on the size, anatomical location, and the number of lesions.
• In those with HPV-related cancer, treatment is usually multidisciplinary in nature, involving surgery, chemo or even radiotherapy.
• STD testing should be considered to pick up any concurrent STD infections.
• Females with HIV should be advised to undergo regular annual cervical cancer screening in view of the higher risk of developing cervical cancer.
• Both male/female with HIV should be advised to consider regular anal screening.

Take home messages

• HPV is a common STD that can cause warts over the affected skin/mucosal surfaces, such as the genitals and the oral region. HPV can also cause HPV-related cancer.
• One with HIV has a higher risk of contracting HPV infection.
• Although HIV and HPV are different infections, they are both STDs.
• Overall, background HIV infection has a deleterious impact on those with concurrent HPV infection, causing more recalcitrant and florid version of warts, increasing susceptibility to developing both HPV-related precancerous and invasive HPV cancers.
• Those with HIV should get vaccinated against HPV (as long as they are age-eligible) and consider regular cervical and anal cancer screening.

If you’re concerned about HIV or HPV, taking action early can make a difference. Talk to our doctors at Dr. Ben Medical Clinic to learn more about screening and preventive care. Contact us to book a consultation.

References:

1. Pavone G et al. Entangled Connections: HIV and HPV interplay in Cervical Cancers-A Comprehensive Review. Int J Mol Sci. 2024 Sep 26;25(19):10358.
2. Liu G et al. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS. 2018 Mar 27;32(6):795-808.
3. Brickman C, Palefsky J. Human papillomavirus in the HIV-infected host: epidemiology and pathogenesis in the antiretroviral era.  Curr HIV/AIDS Rep. 2015 Mar ;12(1):6-15.
4. S Syrjänen. Human papillomavirus infection and its association with HIV. Adv Dent Res. 2011 April;23(1):84-9.
5. Palefsky J. Human papillomavirus-related disease in people with HIV. Curr Opin HIV AIDS. 2009 Jan;4(1):52-6.