Smoking during HIV infection may alter the natural history of HPV infection and increase the risk of cervical disease

Human papillomavirus (HPV) infections in women are both common and clinically important. They have been linked to the development of cervical intraepithelial lesions and to invasive cervical cancer. The frequency of HPV infections and related lesions has been shown to be particularly high among HIV-infected women.

HPV-related cervical diseases have also been linked to smoking, which, like HIV, may play a role in the development of cervical disease, in part through an effect on the immune response to HPV.

A review published more than a decade ago cited 33 epidemiological studies of the association between smoking and cervical cancer. The majority of those works found such an association, and many of those that did not were said to have methodological flaws.

The author of the review concluded: “The evidence would seem to support the conclusion that the association between cigarette smoking and cervical cancer is causal” (p. 955); the results of subsequent work have supported these conclusions. In a recent study, which found a link between smoking and cancer among women with oncogenic HPV infection at baseline, the authors concluded: “Subsequent studies should examine the role of smoking in the multistage pathogenesis of cervical cancer.”

In the current study, HIV-infected (n = 1797) and HIV-uninfected (n = 496) women were assessed every 6 months for type-specific HPV DNA. Smoking status was self-reported. Covariates included age, parity, sexual behavior, HIV load, CD4 cell count, and antiretroviral therapy. Smoking was positively associated with HPV prevalence at baseline in HIV-infected women (P = .002) and was significantly associated with type-specific HPV. In Cox models, detection of HPV was significantly associated with smoking in HIV-infected women (P = .003), but HPV persistence was not (P = .72). The overall likelihood of acquiring persistent HPV was higher in smokers (P = .023) because of greater incidence.

Among HIV-infected women, smoking is associated with a significantly higher prevalence and incidence of HPV infection. Smoking during HIV infection may alter the natural history of HPV infection and increase the risk of cervical disease.

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