Human papillomavirus infection and associated malignancies in HIV-infected people

Jason Ong1,2, Jenny McCloskey2, Winnie Tong3

1.Central Clinical School, Monash University

  1. Department of Clinical Research, London School of Hygiene and Tropical Medicine
  2. Sexual Health Clinic, Royal Perth Hospital, Perth, WA
  3. Department of Clinical Immunology, St Vincent’s Hospital, Sydney, NSW

Last reviewed: November 2019


The human papillomavirus (HPV) is a DNA virus from the papillomavirus family that infects cells at mucosal and cutaneous sites. There are over 170 types of HPV known, of which 40 are sexually transmitted (1). They are generally classified as “low risk” or “high-risk” types depending on their association with malignant transformation of cells (oncogenicity). High risk types include type 16, 18, 31, 33, 35, 45, 51, 52, 56, 58, 59, and 68 (2). HPV-associated malignancies include squamous cell carcinomas (and some adenocarcinomas) of the cervix, anus, oropharynx, vulva, vagina and penis.

Infection with HPV may lead to the development of Squamous Intraepithelial Lesions (SIL). High-grade Squamous Intraepithelial Lesions (HSIL) are considered to be the precursors of squamous cell cancer (SCC). The natural history of HPV infection in the cervix has been extensively studied but further research is needed to understand the natural history of HPV infection in non-cervical sites, particularly the progression and regression rates of cancer precursor lesions. Likewise, treatments for cervical lesions are established but there is still no consensus regarding management of non-cervical lesions.

HPV vaccination is highly effective at preventing infection with HPV vaccine-types (3). This has resulted in marked reductions of the prevalence of warts reported in settings with established HPV vaccination programs (4). The potential of vaccination to reduce HPV-related malignancies will only be realized in the coming decades.

The following section discusses HPV-associated malignancies in general and in people with HIV infection and provides practical information regarding current screening recommendations, clinical presentation of the malignancy, diagnostic considerations and management options. The role of HPV vaccination in the prevention of HPV-associated malignancies in people with HIV infection is also discussed.