The HIV-HPV connection: a concern for the gynecologist

Human immunodeficiency virus (HIV)-positive women are at very high risk of coinfection from human papillomavirus (HPV) and consequently of developing squamous intraepithelial lesions (SIL) of the uterine cervix. The HIV-sieropositive status is also to be considered a risk factor for invasive cervical cancer. The high prevalence of HPV in HIV-positive women would be principally caused by the increased frequency of new infections rather than by being the lower genital tract of these persons more predisposed to give longer hospitality to the virus. There is evidence that reactivation of latent HPV infections is also responsible for the high rates of infections from HPV often detected in HIV-sieropositive subjects. The coinfection from HPV in HIV-positive women mainly seems a tribute paid to the immunodepletion. While in immunocompetent subjects the "wait and see" policy has become the standard management for low grade-SIL/CIN1, the HIV-positive women seem to require a more aggressive approach, also taking into account their poor compliance to gynaecological follow-up.