Document Type
Article
Department
Obstetrics and Gynaecology (East Africa)
Abstract
Background Women living with HIV have an elevated risk for cervical cancer, present earlier, and have more recurrent human papillomavirus (HPV) infections compared with women without HIV. To update WHO recommendations on screening and treatment to prevent cervical cancer, we aimed to identify whether women living with HIV should be screened for cervical cancer at a specific age, the optimal screening interval following a negative cervical screen, and the screening interval following treatment.
Methods We conducted a systematic literature review on cervical cancer and HIV by searching MEDLINE, Embase, CENTRAL, the Cochrane Library, and clinical trial registries covering Jan 1, 2012, through to Oct 13, 2019, updating a previous systematic review covering database inception to July, 2012. Included articles reported original data and assessed one or more outcomes related to cervical precancer and cancer in women living with HIV; no restrictions on study design or setting were made. Articles were excluded if they did not include any women living with HIV, or if they reported only HPV genotype prevalence without any other relevant data. Two authors extracted data from any study reporting cervical cancer screening tests and histopathologically confirmed disease outcomes, by age. We analysed summary data on optimal age and screening intervals, providing pooled estimates when possible; we then conducted an individual patient data meta-analysis (IPDMA) to analyse age-specific data on cervical cancer and precancer. Authors of studies with 40 or more women living with HIV and cervical intraepithelial neoplasia (CIN) grade 2+ were invited to submit individual patient data for meta-analysis. Random-effects models were used to calculate predicted probabilities for cervical cancer screening results by age, HIV status, and antiretroviral therapy (ART) status.
Findings Of the 304 full-text articles screened, 34 studies from 12 countries, with 128 732 women, including 63 790 women living with HIV, were included in the systematic review. Of 55 studies potentially eligible for the IPDMA, eight studies provided data for 72 350 women, 12 527 of whom were living with HIV, from seven countries (Burkina Faso, Cameroon, India, Kenya, South Africa, Thailand, and the USA). In the IPDMA, the pooled predicted probability of CIN2 or CIN3 among women living with HIV increased from 6·0% (95% CI 0·74–64·1) for ages 15–19 years to 32·4% (8·3–72·7) for ages 20–24 years, 42·1% (16·4–80·2) for ages 25–29 years, 50·3% (16·3–80·0) for ages 30–34 years, 47·0% (16·3–80·0) for ages 35–39 years, 49·0% (16·3–80·2) for ages 40–44 years, 58·1% (17·0–81·5) for ages 45–49 years, and 55·3% (21·0–86·6) for age 50 years and older; invasive cervical cancer was uncommon before 30 years of age. In the systematic review, women living with HIV who had a negative baseline cytology result and negative HPV test had a cumulative incidence of developing CIN2+ that ranged from 0·8% to 5% within 4·2–6·4 years and a cumulative incidence of developing of CIN of any grade up to 10% within 12 years. Also in the systematic review, women living with HIV had high recurrence of CIN2+ following treatment (11–27% by 1 year follow-up, 3–64% by 3 years, and 57% by 10 years). No significant evidence of publication bias was found in the data included in the IPDMA (Egger’s test p=0·83).
Interpretation Our data show a clear, age-related increase in CIN2 and CIN3 among women living with HIV, with the highest risk occurring in the 45–49-year age group. Our findings informed WHO recommendations to initiate cervical cancer screening for women living with HIV at age 25 years, with regular screening every 3–5 years. Expanding screening and treatment is necessary to reduce cervical cancer incidence towards its elimination.
Funding US Agency for International Development and US President’s Emergency Plan for AIDS Relief.
Publication (Name of Journal)
The Lancet HIV
DOI
https://doi.org/10.1016/S2352-3018(25)00198-5
Recommended Citation
Dalal, S.,
Sundström, K.,
Silva, R.,
Taghavi, K.,
Cejtin, H.,
Chung, M.,
Greene, S.,
Joshi, S.,
Kelly, H.,
Orang'o, E.
(2025). Age-specific distribution of cervical precancer and cancer among women living with HIV across seven countries: a systematic review and an individual patient data meta-analysis. The Lancet HIV, 1-12.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_obstet_gynaecol/760
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This work is licensed under a Creative Commons Attribution 3.0 License.