Cervical Cancer and Women Living with HIV

Cervical cancer is known to be the fourth most common cancer occurring in women. Additional research has been conducted in countries where a high prevalence of HIV and cervical cancer exist. Studies have shown that women living with HIV have a higher risk for cervical cancer compared to their HIV-negative peers.¹

The goal to eliminate cervical cancer

Although cervical cancer is one of the most common cancers, it is also considered to be the most preventable cancer.¹ In addition, just as there is a goal to end HIV by 2030, health officials are also working to eliminate cervical cancer within the same timeframe.

Access to prevention, screening, and treatment

In order to do this, efforts are being made to increase access to treatment, screening, and the human papillomavirus (HPV) vaccine. Although a small percentage of people infected by HPV develop cervical cancer, immunosuppression caused by untreated HIV infection can lead to the risk of HPV being enlarged.¹

The World Health Organization outlines 3 goals to eliminate cervical cancer by 2030:¹

• 90 percent of girls receive the HPV vaccine by 15 years of age.
• 70 percent of women screened for cervical cell abnormalities by the age of 35 and screened again by the age of 45.
• 90 percent of women diagnosed with cervical disease receive treatment.

Cervical cancer and HIV

Dominik Stelzle of the Technical University of Munich and Dr. Shona Dalal of the World Health Organization (WHO) conducted a global study between 1981 and 2014. Eight countries in Africa, three in Asia, four in western Europe, and two in North America.

The goal of this study was to research cervical cancer rates among women living with HIV, specifically including low-middle income countries (17). The study consisted of 236,127 women living with HIV in which 40 percent were actively taking antiretroviral therapy medication. All women were aged 15 years and over with a median age of 38 years.¹ Their results were consistent showing women with HIV had a six-fold increase in the risk of developing cervical cancer.¹

Using additional data from 2018 to support their findings, Stelzle and Dalal discovered that there were approximately “33,000 new cases of cervical cancer among women with HIV in 2018  [in which] 5.8 percent of all [were] new cases."¹ It was also noted that those primarily affected lived in the African regions - 64 percent of all cases were in southern Africa.¹

Why is there an increased risk?

Researchers found that there is a wide array of factors associated with the increased risk of cervical cancer in women with HIV. Some of these risks include but not limited to:¹

• Women living with HIV that acquire an HPV infection are less likely to clear infection than women without HIV.
• Cervical cancer is high among women with a low CD4 cell count and not taking antiretroviral therapy medication.
• Disease recurrence after treatment due to immune suppression

Early detection is key

It is vital to expand access to the HPV vaccine in areas of high HIV prevalence to reduce cervical cancer risk. Stelzle and Dr. Dalal “believe that integrating cervical screening into routine, six-monthly HIV care could mean that pre-cancerous cell changes are spotted early, therefore allowing for prompt treatment.”¹

In addition, if we are able to successfully achieve the aforementioned goals, scientists believe eliminating cervical cancer will no longer seem like an impossible dream.