(PL35) UNDERSTANDING THE IMPACT OF ANTIRETROVIRAL THERAPY AND OTHER FACTORS ON HPV CLEARANCE IN CISGENDER WOMEN WITH HIV/HPV CO-INFECTIONS IN THE DC COHORT, 2016-2023

Background:
Women with HIV are at elevated risk for HPV. Antiretroviral therapy (ART) treats HIV; however, no pharmacological treatment for HPV exists. Prior studies have shown varied effects of ART class on HPV clearance, with only some demonstrating an association between ART class and HPV clearance. Our objective was to evaluate the association between ART class and HPV.

Methods:
This retrospective cohort study used data from the DC Cohort Longitudinal HIV study (2016-2023). We investigated HPV clearance among 184 women with HIV/HPV co-infection, comparing two ART classes at time of HPV diagnosis: protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs). ART class and HPV clearance were classified dichotomously using electronic health record data, including pap smear, biopsy, and HPV testing. Descriptive statistics were performed to compare characteristics by HPV clearance status. Cox proportional hazards models and Kaplan Meier curves were used to assess differences in time to HPV clearance.

Results:
Among 184 women, a large proportion were Non-Hispanic Black (94.0%), public insurance recipients (76.1%), current smokers (48.4%), receiving care at a community-based DC Cohort clinic (70.1%), and cleared their HPV infection (74.5%). Those who didn’t achieve HPV clearance exhibited CD4 counts < 200 cells/mm3 (p=0.02), HIV viral load ≥ 200 copies/mL (p=0.01) and were current smokers (p=0.02). Current smoking, compared to past or never smoking, was associated with a longer time to HPV clearance (HR = 0.60, 95% CI: 0.42, 0.85). PIs did not significantly impact time to HPV clearance compared to INSTIs (HR = 1.47, 95% CI: 0.90, 2.40).

Conclusion:
This study suggests that CD4 count, viral load, and smoking status, but not ART class, may influence HPV clearance among women with HIV. Our results elucidate the influence of clinical and sociodemographic factors, including ART, that influence HPV clearance amongst people with HIV.