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Meta-Analysis
. 2021 Feb;9(2):e161-e169.
doi: 10.1016/S2214-109X(20)30459-9. Epub 2020 Nov 16.

Estimates of the global burden of cervical cancer associated with HIV

Dominik Stelzle  1 , Luana F Tanaka  2 , Kuan Ken Lee  3 , Ahmadaye Ibrahim Khalil  4 , Iacopo Baussano  4 , Anoop S V Shah  5 , David A McAllister  6 , Sami L Gottlieb  7 , Stefanie J Klug  2 , Andrea S Winkler  8 , Freddie Bray  4 , Rachel Baggaley  9 , Gary M Clifford  4 , Nathalie Broutet  7 , Shona Dalal  10
Affiliations
Meta-Analysis

Estimates of the global burden of cervical cancer associated with HIV

Dominik Stelzle et al. Lancet Glob Health. 2021 Feb.

Erratum in

Abstract

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 age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer.

Findings: 24 studies met our inclusion criteria, which included 236 127 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 (33 000 new cases, 95% CI 26 000-42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6-6·4) were attributable to HIV infection (28 000 new cases, 20 000-36 000). 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 (14 000 new cases, 12 000-17 000). 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.

Funding: WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.

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Figures

Figure 1
Figure 1
Risk of developing cervical cancer among women living with HIV, by type of study
Figure 2
Figure 2
Risk of developing cervical cancer among women living with HIV, by subgroups Meta-regression to assess interaction was not significant for risk of bias (p=0·96), year of publication (p=0·77), or country income group (p=0·46).
Figure 3
Figure 3
Estimated population attributable fraction for cervical cancer and HIV in the 50 highest ranked countries Estimates are ranked from highest to lowest proportion. The figure shows data for 48 countries; data for Turkmenistan (European; 5–9·99%) and Trinidad and Tobago (Americas; <5%) are not shown because HIV estimates are not published by UNAIDS.
Figure 4
Figure 4
Maps showing cases of cervical cancer attributable, or not, to HIV (A) Population attributable fraction of women with cervical cancer living with HIV in 2018. (B) ASIR attributable to HIV (per 100 000) in 2018. (C) ASIR not attributable to HIV (per 100 000) in 2018. ASIR=age-standardised incidence rate.
See this image and copyright information in PMC

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