A research team has quantified the effects of infection with the human immunodeficiency virus (HIV) on the development of cervical cancer. Their results show that the risk of developing cervical cancer is six times higher in women who are infected with HIV, and that women who live in Southern and Eastern Africa may be particularly at risk. These findings were published by Stelzle et al in The Lancet Global Health.

According to World Health Organization (WHO) statistics, cervical cancer is the fourth most common type of cancer diagnosed in women worldwide. In 2018, an estimated 570,000 women were diagnosed with cervical carcinoma across the globe, and approximately 311,000 of these women died of the cancer.

Cervical cancer is often viewed as one of the most successfully preventable and treatable types of cancer, as long as it is detected at an early stage and treated effectively. Cervical cancer is also the most frequently detected cancer for women who live with HIV.

Systematic Review and Meta-analysis

Researchers conducted a systematic review as well as a meta-analysis of a total of 24 studies from the years 1981 to 2016, which included data from 236,127 women with HIV from four continents (Africa, North America, Asia, and Europe).

These studies covered a total of 2,138 cervical carcinoma cases. The results were linked with data from UNAIDS on worldwide HIV infection and with data on cervical carcinoma from the International Agency for Research on Cancer (IARC), the WHO's Cancer Research Center.

“Until now, there have only been estimates from countries with high net income levels,” said first study author Dominik Stelzle, MD, of the Technical University of Munich, in a statement. “That's why we looked at the figures on global incidence of cervical carcinoma in connection with HIV infection and included estimates for countries with low net incomes. In most parts of the world, the numbers are under 5%. In some countries, however, we're talking about well over 40% of cases."

Risk Is Higher for Women With HIV

The objective of the study was to calculate the share of women living with HIV among the number of women with cervical cancer. The authors found that 5.8% of all new cervical cancer cases worldwide in the year 2018 were diagnosed in women infected with HIV. This is equivalent to 33,000 cases a year—85% of which occurred in women living in sub-Saharan Africa.

Furthermore, based on their results, the team was able to show that women with HIV have a sixfold higher risk of developing cervical cancer than women without HIV infection.

“The association between cervical carcinoma and HIV is plausible,” said coauthor Andrea S. Winkler, PhD, also of the Technical University of Munich. “Cervical carcinomas are usually caused by infections with HPV, which [is] sexually transmitted just as HIV is. Based on our results, it can be assumed that an infection with HIV represents a risk factor for an infection with HPV.”

Southern and Eastern Africa Most Affected

The regions most strongly affected were southern and eastern Africa, where, respectively, 63.8% and 27.4% of cervical carcinomas were diagnosed in women infected with HIV.

“With over 75%, Eswatini in southern Africa is the country with the highest share of women suffering from cervical cancer in connection with an HIV infection, followed by Lesotho with 69%, Botswana with 67%, South Africa with 64%, and Zimbabwe with 52%,” said researchers.

Based on the results, the authors determined that women with HIV have a significantly higher risk of developing cervical cancer. They also pointed out that this means that HPV vaccinations and early-stage cervical carcinoma screenings are of particular importance, especially in the African countries south of the Sahara.

“Although cervical cancer screenings already exist in Africa, until now they have been performed primarily on women with a higher socioeconomic status who could afford the screening,” said coauthor Stefanie Klug, PhD, also of the Technical University of Munich. “The goal has to be to end this dependency on economic means and to succeed in introducing free HPV vaccination for girls and screening for adult women.”

Disclosure: For full disclosures of the study authors, visit thelancet.com.