Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India

A new study conducted by researchers from the International Agency for Research on Cancer (IARC) and local partners in Pune, India, provides information on the incidence of high-grade cervical precancerous lesions (cervical intraepithelial neoplasia grade 2 or 3; CIN2/3) in women living with HIV (WLHIV) according to their human papillomavirus (HPV) infection status, and follow-up outcomes of women treated for CIN2/3 with thermal ablation. The results were published in the International Journal of Cancer.

WLHIV who had persistent infection with a high-risk HPV type had a 138-fold increase in the risk of CIN2/3 or cancer (CIN grade 2 or worse; CIN2+) compared with WLHIV who were HPV-negative at baseline. The incidence of CIN2+ in the study cohort of WLHIV was 7.0 per 1000 person-years of observation. Of the HPV-positive WLHIV who were treated for CIN2/3 with thermal ablation, about two thirds had complete regression of disease; however, almost 45% had persistent HPV infection. Of the WLHIV who were HPV-negative at baseline, 87% remained HPV-negative throughout, and no CIN3 or cancer was detected in this group over a period of 5 years.

The observation that HPV-negative WLHIV have a very low risk of developing CIN3 or invasive cancer within a follow-up period exceeding 5 years provides an early indication that the currently recommended screening interval of 3–5 years in WLHIV may be extended to at least 5 years in HPV-negative WLHIV. Increasing the screening interval can reduce costs and improve scalability in WLHIV, to support the World Health Organization cervical cancer elimination initiative.

WLHIV have a risk of developing cervical cancer that is nearly 6 times that of HIV-negative women. In spite of this significantly higher risk of cervical cancer in WLHIV, there is a paucity of evidence related to the natural history of the cancer, the efficacy of screening approaches, and the response to treatment of precancers.

Joshi S, Muwonge R, Kulkarni V, Mandolkar M, Lucas E, Pujari S, et al.
Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India
Int J Cancer, Published online 19 July 2022;
https://doi.org/10.1002/ijc.34221

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