article · HIV Medicine
Women living with HIV face higher risks from cervical disease, as screening and precancer treatments are generally less effective for them. A cohort of 241 women living with HIV in Zambia underwent visual inspection with acetic acid, high-risk human papillomavirus testing, and biopsies, with follow-up conducted 30 to 36 months later. Over this period, the prevalence of high-risk human papillomavirus dropped from 44 percent to 24 percent, while high-grade cervical disease fell from 25 percent to 9 percent. Precancer treatment notably increased the odds of disease regression nearly threefold and reduced the odds of progression. However, one-third of the women who presented with high-grade disease at the follow-up stage had received previous treatment. These outcomes demonstrate that precancer treatment effectively reduces disease progression in this population, though treatment effectiveness requires further optimisation to avoid overtreatment.
Cervical cancer is a preventable condition, but women living with HIV experience poorer outcomes from standard care. This study provides clinical evidence that screening and treating precancerous lesions significantly lowers disease rates in this population over time. It highlights the direct impact of existing health interventions while identifying the ongoing risk of recurrence or persistence.
The findings inform clinical protocols, screening guidelines, and public health programmes managed by healthcare providers and health authorities targeting cervical cancer elimination. Based on an applied observational cohort study, the clinical practices evaluated are already in use, but the data indicates a need to improve the efficacy of existing treatment tools and follow-up strategies for women living with HIV.
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OBJECTIVES: Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia. METHODS: Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression. RESULTS: Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment. CONCLUSIONS: Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
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DOI: 10.1111/hiv.70134
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