Background:  Several studies show that the human papilloma virus (HPV) -associated cervical, anal, and oral cancers are more common in HIV⁺ persons than the general populations. Cervical cancers remain a significant health problem predominantly in developing countries. In these countries, the risk of cervical cancer is 16- to 37-fold higher in HIV-infected women also infected with HPV than in the HIV-uninfected. Unfortunately, studies show only a moderate effect of HAART on the incidence of precancers including high-grade squamous intra-epithelial lesions (HSIL). This may not be surprising since data suggest that the relationship with HIV is not only associated with impaired CD4 T cell counts, but also with alterations in mucosal immunity. These include lower levels of antigen-presenting cells in cervical tissue in HIV⁺ women and altered cytokine expression profiles. As women live longer, it has been speculated that cervical cancer rates may in fact increase among HIV⁺ women. Studies have also shown that the distribution of HPV types in HIV⁺ women with cervical HSIL and cancer differ from those of HIV-uninfected women with lower rates of HPV-16 than in the general population and higher rates of other types, specifically 52 and 58. Multiple-types infections are also more common and have been associated with prolonged persistence in HIV⁺ and HIV­^– women. Similar to cervical cancer, anal cancer is higher in HIV⁺ men and women and HAART appears to have limited beneficial effect. HPV-16 is more common in anal cancers than cervical cancers. Recent data underscore the role of HPV in oropharyngeal cancers with more than 25% of oral cancers associated with HPV. As with other HPV-related cancers, oropharyngeal cancers occur at higher rates in HIV⁺ men and women than in the general population. Oral HPV infections range from 14 to 35% in HIV⁺ persons with HPV-16 as the most common type.

Conclusions:  It is expected and hoped that the HPV vaccine will be beneficial to HIV⁺ children prior to HPV exposure, as expected in non-immunocompromised children. Studies are underway to examine its safety and immunogenecity in this group. Unfortunately, no data are available regarding HPV genital persistence in HIV⁺ children exposed to HPV at birth. Therefore, efficacy studies in this group are sorely needed. It is also hoped that HPV vaccines will be effective in stopping recurrent infections or reactivation in those HIV⁺ and HPV-exposed. HPV vaccine could also significantly affect anal and oral cancers in HIV⁺ persons if administration is timed correctly.