Online Reporter
Tendai Gukutikwa
Health Reporter
PEOPLE living with HIV face a significantly increased risk of developing HPV-related diseases, including several forms of cancer, due to weakened immune systems that make it harder for the body to clear human papillomavirus (HPV) infections, a leading specialist has warned.
Speaking during an online training session for healthcare workers on HPV-related diseases among people living with HIV, Newlands Clinic Medical Director Dr Margaret Pascoe said the interaction between HIV and HPV creates a dangerous combination that can accelerate the development of pre-cancerous lesions and cancer.
“HPV is one of the most common viral infections. More than 450 types have been identified, including both low-risk and high-risk strains,” said Dr Pascoe.
She explained that the virus primarily infects cells lining the skin and mucous membranes and is mainly transmitted through close skin-to-skin contact. In some cases, transmission can also occur from mother to child around the time of birth.
While most HPV infections resolve naturally without causing symptoms, Dr Pascoe said persistent infections remain a major public health concern.
“Most infections are subclinical and clear spontaneously within two years. However, persistent infection may occur in about 20 percent of individuals, leading to dysplasia, which is abnormal cell growth, and eventually cancer,” she said.
According to Dr Pascoe, people living with HIV are particularly vulnerable because HIV weakens the body’s ability to fight off HPV infections.
“HIV and HPV are a dangerous synergy. HIV-related immune suppression compromises the ability to clear HPV, while HIV also drives chronic inflammation that promotes carcinogenesis,” she said.
She noted that women living with HIV face an especially high risk of cervical cancer, one of the most common HPV-related malignancies.
“Women living with HIV have a six-fold increased risk of cervical cancer. This is particularly important because effective antiretroviral therapy means people living with HIV are now living longer, healthier lives, yet HPV-related cancers are emerging as a significant cause of illness and death,” said Dr Pascoe.
She urged healthcare providers to integrate HPV prevention into routine HIV care, saying it was critical to reducing the burden of HPV-related diseases.
“Prevention is a pillar of elimination. HIV prevention and control is integral to eliminating HPV-related disease,” she said.
Beyond cancer, Dr Pascoe highlighted that certain HPV strains cause genital warts, which, although non-cancerous, can have a significant impact on patients’ quality of life.
She said genital warts can develop in different areas of the genital and anal regions and vary greatly in appearance.
“They can occur at any site of contact, including the penis, urethra, vulva, vagina, cervix, pubic area, perineum and around the anus. They can appear as small papular lesions or larger, sometimes cauliflower-like growths,” she said.
Treatment options, she said, differ from patient to patient and may include topical medications, cryotherapy, laser treatment or surgery.
Dr Pascoe underscored the importance of addressing HPV-related cancers, particularly cervical cancer, which remains one of the most common consequences of persistent infection with high-risk HPV strains.
“About 90 percent of cervical cancers are caused by HPV,” she said.
She noted that cervical cancer is unique because it is considered the first cancer that can potentially be eliminated through comprehensive public health interventions.
“Cervical cancer is the first cancer deemed amenable to elimination. We have the 90-70-90 targets, which involve HPV vaccination, screening and treatment,” she said.
Given their elevated risk, women living with HIV should undergo regular screening to ensure early detection and treatment of pre-cancerous lesions, Dr Pascoe added.
She also drew attention to anal cancer, another HPV-related disease that disproportionately affects certain high-risk groups.
“About 88 percent of anal cancer is attributable to HPV types 16 and 18. People living with HIV are among the populations at increased risk,” she said.
Early detection and treatment of pre-cancerous anal lesions, she noted, can significantly reduce progression to invasive cancer.
Penile cancer is another condition strongly linked to HPV infection.
“About 95 percent of penile cancers are squamous cell carcinoma. HPV is the most important risk factor, with more than 50 percent attributable to HPV and about 73 percent caused by HPV 16 and 18,” said Dr Pascoe.
She stressed the need for increased awareness among both healthcare workers and patients, coupled with routine clinical examinations and wider uptake of HPV vaccination.
Treatment for penile cancer depends on the stage of the disease and may include topical chemotherapy creams, cryotherapy, laser therapy, surgery, radiotherapy or chemotherapy.
Dr Pascoe further highlighted the growing burden of vulval cancer among women living with HIV, warning that cases are increasing and often affect younger women than in the general population.
“HPV-related vulval cancer is increasing in prevalence, especially among women living with HIV. The disease also occurs at a much younger age in women living with HIV, and patients often present with advanced disease,” she said.
She said better awareness among both patients and healthcare professionals could lead to earlier diagnosis and improved outcomes.
“If women living with HIV and healthcare providers are more aware of the disease, we can diagnose it earlier. Although HIV infection is associated with poorer survival, treatment protocols remain the same,” she said.
Meanwhile, Dr Pascoe announced that Zimbabwe is set to launch the Zimbabwe chapter of the International Papillomavirus Society in September. The new chapter is expected to spearhead education, advocacy, research and strategic partnerships aimed at reducing the burden of HPV-related diseases in the country.
The initiative is also expected to strengthen efforts towards HPV prevention, screening and treatment, particularly among vulnerable populations such as people living with HIV.
