Global Estimates of the HPV-related, Noncervical Cancer Burden in People With HIV and AIDS and the Potential Effect of Improved HPV Vaccine Coverage in This Population: A Systematic Review, Meta-analysis and Modeling Study

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Background: While HIV/HPV coinfection significantly increases cervical carcinogenesis, the relationship with HPV-related noncervical cancers is less understood. HPV vaccination is key in prevention, but global coverage is low (21%). We aimed to quantify the risk of noncervical cancers among people living with HIV and AIDs (PWHA), estimate this cancer burden globally, and the impact of improved HPV vaccine coverage. Methods: We conducted a systematic review and meta-analysis of 3 databases to identify studies comparing HPV-related noncervical cancer risk in PWHA and HIV negative populations, generating a risk ratio for each cancer. This was combined with country-specific HIV prevalence and the incidence of cancer cases to calculate the burden. Vaccine impact was estimated using vaccine coverage data and point efficacy estimates. Results: 25 studies were included analyzing 1 560 923 million PWHA. The risk of developing each HPV-related noncervical cancer was significantly increased in PWHA. The pooled risk was 30.32 (CI 20.54-44.75) for anal, 15.78 (CI 4.62-53.92) for vaginal, 6.99 (CI 3.37-14.51) for vulvar, 6.37 (CI 3.98-10.21) for penile, and 2.74 (CI 2.10-3.58) for oropharyngeal cancers. Globally, 30% of cases in Africa were HIV-attributable, compared with 5% worldwide. If HPV vaccination coverage increased to 90%, we could prevent 1987 more cancer cases, assuming 50% vaccine efficacy. Conclusions: This meta-analysis confirms that PWHA are more susceptible to adverse outcomes beyond cervical cancer and must be prioritized in HPV prevention and vaccine efficacy research. In countries with high HIV/HPV coinfection prevalence, integrating HPV vaccination with HIV services could minimize disparities in the cancer burden worldwide.

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