Incidence and progression of cervical lesions in women with HIV: a systematic global review

Abstract

Global data on cervical lesion incidence and progression in HIV-positive women are essential for understanding the natural history of cervical neoplasia and informing screening policy. A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Of 5882 HIV-positive women from 15 studies, incidence ranged from 4.9 to 21.1 cases per 100 woman-years for any cervical lesion and 0.4 to 8.8 cases per 100 woman-years for high-grade cervical lesions. HIV-positive women showed a median three-fold higher incidence of cervical lesions compared to HIV-negative women. Of 1099 HIV-positive women from 11 studies, progression from low- to high-grade lesions ranged from 1.2 to 26.2 cases per 100 woman-years. Both incidence and progression rates increased with lower CD4 counts. The effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear. HIV-positive women have higher incidence and progression of cervical neoplasia. Cervical cancer screening should be integrated into HIV treatment programmes.

Keywords: AIDS; CIN; HIV; SIL; cervical cancer; cervical lesions; incidence; progression; review; screening; squamous epithelial lesions; women.

Conflict of interest statement

Disclosure of interests:

The authors declare no competing interests.

Figures

Figure 1

Incidence rates reported or calculated for LSIL (A) or HSIL (B) in HIV-positive women. Rates are reported as cases per 100 woman-years. Solid lines show unweighted mean rate. Dotted lines show 95% confidence intervals around the unweighted mean. *This study reports CIN2–3.