With improved access to antiretroviral therapy (ART) and related care, young people born with HIV in the Asia-Pacific are growing up into adults. In 2016, there were about 190,000 HIV-positive adolescents aged 10−19 years in the region. As they become sexually active, these youth are also at risk for sexually transmitted infections (STIs).
The most frequently acquired STI is human papillomavirus (HPV) infection, which can result in cervical cancer—the second-most common cancer in women in Southeast Asia and a major cause of death. HPV infection persists until the body naturally clears the virus. Having HIV decreases the chances of HPV clearance, increasing the risk of persistent infection. Although there is a vaccine to prevent HPV, it is not widely available in most low- and middle-income countries in Asia.1
A site monitoring visit to Chiangrai Prachanukroh Hospital
TREAT Asia and the Thai Red Cross AIDS Research Center are approaching the end of a six-year observational study comparing HPV infection and its outcomes in perinatally HIV-infected youth (PHIV) and HIV-negative youth in Thailand and Vietnam. The study is supported with funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Austrian AIDS organization, LIFE+.
“Because of their higher risk, we need to be more active in treating patients with coinfection of HPV and HIV.”
“This study provided an opportunity to monitor cervical cancer and other STIs in this high-risk population, and to provide them with additional health services and information,” said study investigator Dr. Rawiwan Hansudewechakul of Chiangrai Prachanukroh Hospital in Chiangrai, Thailand. “At every visit, the adolescents were informed about their test results, counseled on sexual education and family planning, and encouraged to bring their partners for an HIV checkup.”
The study was implemented with extensive support and input from the community. “The Chiangrai Community Advisory Board (CAB) and infected/affected families helped find participants for the study and assisted with participant retention through their community network,” said Dr. Hansudewechakul. “This created a strong connection between communities, families, and hospitals, and the CAB and the young people’s families learned more about HPV.”
Dr. Kulkanya Chokephaibulkit of Siriraj Hospital in Bangkok, Thailand, added “At our site, the study enabled us to perform outreach to adolescents at risk, improve our working experience with adolescents on sexual and reproductive health, and diagnose and treat STI/HPV-related problems earlier. It also increased the adolescents’ awareness and self-care regarding STIs.”
Study investigators meet in Chiangrai, Thailand. (Please click on picture to enlarge.)
Initial analyses showed that female PHIV were found to be more likely than the HIV-negative adolescents to have infection with the high-risk types of HPV commonly associated with cancer, and abnormal Pap smear test results. Across both groups of adolescents, those with two or more sex partners were also more likely to have acquired a high-risk HPV infection. Final study results will be available in early 2018.
“Because of their higher risk, we need to be more active in treating patients with coinfection of HPV and HIV,” said investigator Dr. Hanh Le Dung Dang of Hung Vuong Hospital in Ho Chi Minh City, Vietnam. “People living with HIV need reproductive health services, and we should organize reproductive health care especially for them.”
“This study also revealed a service gap for adolescents,” continued Dr. Dang. “We have clinics and hospitals for children and adults, but they are not appropriate for adolescents. The Children’s Hospital has no sexual or reproductive health services or even the appropriate instruments to investigate these issues in adolescents, and the adolescents are shy about going to an adult hospital.”
Currently most Asian countries lack national policies supporting expanded HPV vaccination and do not prioritize those with HIV. This study adds to the evidence supporting the need for vaccination against HPV to prevent cervical cancer in PHIV who are at especially high risk for HPV infection and persistence.
1amfAR/TREAT Asia. (2016). Cervical Cancer, Human Papillomavirus (HPV), and HPV Vaccines in Southeast Asia: Key Considerations for Expanding Vaccine Coverage and Improving Population Health http://www.amfar.org/uploadedFiles/_amfarorg/Articles/Around_The_World/TreatAsia/2016/hpvbrief1.pdf