HUMAN PAPILLOMA VIRUS AND HUMAN IMMUNODEFICIENCY VIRUS THE STORY SO FAR

HUMAN PAPILLOMA VIRUS (HPV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)

HUMAN PAPILLOMA VIRUS AND HUMAN IMMUNODEFICIENCY VIRUS – Cervical cancer is the fourth most common cancer among women worldwide with lung and breast cancer being first and second respectively. The Human Papilloma Virus (HPV) is responsible for causing cervical cancer disease. In 2018, an estimated 570,000 new cases were recorded globally representing 6.6% of all female cancers which showed an increase from previously 274,000 in 2012. The mortality rate resulting from cervical cancer in low- and middle- income countries occurs at a higher rate compared to the developed countries.

About 372.2 million women live in Africa aged 15 years and older. These women are at risk of developing cervical cancer. Current statistics indicate that every year about 119,284 women are diagnosed with cervical cancer and an estimated 81,687 die from the disease. In West Africa, out of 104,650 women, 32,952 are at risk of developing the disease. The story is however different in Ghana. Women in Ghana represent a population of 8.57 million aged 15 years and older who are at risk of developing cervical cancer. According to a report by the Institut Catala d’Oncologia in 2018, Spain, estimated that every year about 3,151 women are diagnosed with cervical cancer. Out of the 3,151 women, 2,119 die from the disease. In Ghana, cervical cancer ranks second in the cancer chart with breast cancer being the first.

The introduction of the Papanicolaou test (Pap test) over the years has decreased the incidence of cervical cancer by one-third but despite its apparent success, cases of cervical cancer screening are increasingly high due to missed Pap tests, inadequate follow-ups and inaccurate cytology results.

It should be noted that HPV infection is considered to be a sexually transmitted disease and several factors could trigger its development aside from the virus itself. Such factors may include immunosuppressed conditions, environmental factors and host factors that may interact with the development of cervical cancer. Immuno- suppressed conditions predispose women to several opportunistic infections. One of the most studied and documented immunosuppressed conditions is the one caused by the Human Immunodeficiency Virus (HIV). The HIV infections had it molecular, immunologic and genetic factors associated with the progression of HPV infections to dysplasia in immune-competent and HIV- infected women were studied. Some of these studies, however, ended up in mixed results.

HUMAN PAPILLOMA VIRUS (HPV) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)

The HIV infections over the years have been known for its ability in the suppressing the host immune system. The infection alters with the cell-mediated immunity of the host, as a result, facilitates the acquisition of opportunistic infections. The actions of the virus limit the host’s ability to effectively produce or elicit the right immune response. Higher HPV infections have since been documented among HIV-infected women due to their suppressed immune system.

This contributes to new infections involving other HPV types being acquired (multiple infections or co-existence of one or two HPV genotypes). The HIV infection cannot be cleared completely from the system and this leads to HPV persistence in the body. Persistence HPV infection increases the risk of developing High-grade Squamous Intraepithelial Lesion (HSIL) and cervical cancer. In immune-competent or young healthy women, 90% of HPV infection clears up in a duration of 8 months after they have been infected. Some women may, however, take at most two years to clear and may never develop these cancers.

HUMAN PAPILLOMA VIRUS AND HUMAN IMMUNODEFICIENCY VIRUS

Its long-term existence in the host system allows the HPV to efficiently replicate and integrate its viral oncoproteins (E6 and E7) into the host genome, mutations that occur during transcription of the human papillomavirus becomes accumulated leading to genomic instability and chromosomal aberrations of the host cells. These changes brought about by HPV causes rapid morphological changes to host cells contributing to cervical cancer development.

It should be noted that the prevalence of mild dysplasia among immune-competent women does not exceed 27% but it can rise to 80% in HIV- positive women.

The relationship between HIV and HPV has been documented as a worldwide public health concern. However, over the years, the relationship that exists between the two infections has been shown to have a low correlation in the development of neoplastic lesions. This is partly due to the advent of antiretroviral therapy (ART). Such correlation is different in low-income countries due to the limited access to antiretroviral therapy (ART).

The knowledge regarding the distribution of HPV genotypes has become necessary worldwide due to the introduction of the two HPV vaccines. The efficacy of the two vaccines available, the bivalent (Cervarix, GlaxoSmithKline) and the quadrivalent (Gardasil; Merck and Co., Inc), has been well documented. However, the efficacy of these vaccines in curbing the incidence of cervical cancer is dependent upon the prevalence of oncogenic vaccine genotypes (HPV 16 and 18) in a given population.

Global prevalence studies suggest that the two oncogenic HPV genotypes included in the available vaccines, HPV 16 and 18 (the quadrivalent vaccine also protects against HPV 6 and 11, which cause genital warts but are low risk with regards to cervical cancer), account for approximately 70% of cervical cancer worldwide. HPV vaccine distributions in Ghana started in 2013 and have covered over 100,000 girls from the ages of 9-13 years. Studies from Tanzania have correlated human immunodeficiency virus (HIV) infection with HPV genotypes 16 and 18, which have been most frequently associated with malignant transformation.

Immunity to HPV virus-like particle vaccines is type-specific therefore the distribution of the genotypic characterization of HPV is key in the reduction of the mortality rates associated with the infection. Immuno-compromised conditions such as HIV infection increases the prevalence of HPV among women.

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HUMAN PAPILLOMA VIRUS AND HUMAN IMMUNODEFICIENCY VIRUS

Ghana Health News

By Wright Amesimeku GHN