Cytologic and histologic cervical lesions and oncogenic HPV in women living with HIV (WLHIV) despite viral suppression: first evidence from Algeria

Abstract

BACKGROUND: Women Living with HIV (WLHIV) are at increased risk of persistent high-risk Human Papillomavirus (HR-HPV) infections and cervical cancer. However, data on HPV genotype distribution and cervical cytologic abnormalities remain limited in North Africa, particularly among women receiving effective antiretroviral therapy (ART). OBJECTIVE: To assess the frequency of cytologic abnormalities in WLHIV in Sétif, Algeria, identify HR-HPV genotypes, and evaluate associated immunovirological factors. METHODS: A cross-sectional study was conducted from January to December 2024 at the HIV/STI/AIDS Reference Center in Sétif. WLHIV aged ≥ 18 years who provided informed consent were included. Each participant underwent a gynecological examination, cervical cytology (Pap smear), HR-HPV genotyping by molecular biology, and immunovirological assessment (CD4 T-cell count, HIV viral load). Colposcopy and biopsy were performed when indicated. RESULTS: Among 115 enrolled participants, 100 smears were interpretable. Cytologic abnormalities : Atypical Squamous Cells of Undetermined Significance (ASC-US), Low-Grade/High-Grade Squamous Intraepithelial Lesions LSIL, HSIL) were found in 28% of WLHIV. HR-HPV infection was detected in 32% of participants, mainly genotypes HPV52, HPV16, and HPV18. A significant association was observed between HR-HPV positivity and high-grade lesions (HSIL) (p = 0.018; OR = 9.57, 95% CI: 1.02-89.48). CONCLUSION: WLHIV in Algeria show a high prevalence of HPV-related cytologic abnormalities, even with adequate immune status and viral suppression. These findings emphasize the importance of regular cervical screening and support current global recommendations for comprehensive prevention strategies, including HPV testing and vaccination.