Estimates of the global burden of cervical cancer associated with HIV

Background HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. Methods We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org ], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and agestandardised incidence rates (ASIRs) of HIV-attributable cervical cancer. Findings 24 studies met our indusion criteria, which induded 236127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6.07,95% CI 4.40-8.37). Globally, 5.8% (95% CI 4.6-7.3) of new cervical cancer cases in 2018 (33000 new cases, 95% CI 26000-42000) were diagnosed in women living with HIV and 4.9% (95% CI 3.6-6.4) were attributable to HIV infection (28000 new cases, 20000-36000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63.8% (95% CI 58.9-68.1) of women with cervical cancer (9200 new cases, 95% CI 8500-9800) were living with HIV, as were 27.4% (23.7-31-7) of women in eastern Africa (14000 new cases, 12000-17000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Interpretation Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Copyright (C) 2020 World Health Organization; licensee Elsevier.

Automated summary

HIV infection significantly increases the risk of cervical cancer, especially in countries in southern Africa and eastern Africa. The burden of HIV-attributable cervical cancer is substantial, with a significant proportion of new cases diagnosed among women living with HIV.