In this HIV-infected South African population, stratifying hrHPV-positive women with reflex methylation analysis detects all cervical carcinomas and yields an acceptable sensitivity and specificity for CIN3+.

HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV-and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to agespecific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.

A high number of women in South Africa with cervical cancer are HIV positive. Without viral cross-protection, HPV vaccines should prevent around 65% of cervical cancers in this population. Human papillomavirus type 45 infection is significantly linked to HIV and important for future vaccine developments.

In South Africa, burdened by the HIV pandemic, high numbers of high- and low-risk HPV type infections are present in women with cervical preneoplasia. HPV type distribution differs among varying levels of HIV-induced immune depletion.

Objectives: South Africa women with cervical carcinoma present at younger ages and the majority with advanced-stage disease. Certain patients may have a favourable outcome after placement of a percutaneous nephrostomy (PCN) for obstructive uropathy in cervical cancer. Methods: A retrospective audit was conducted at the Gynaecological Oncology Unit, University of Pretoria. All patients with primary untreated cervical cancer with renal impairment secondary to obstructive uropathy were included. Urea, creatinine and potassium were recorded for patients receiving PCN before insertion and after treatment. Results: In total, 54 patients were included. The mean age was 49.5 years. The number of patients receiving PCN was 28 (51.9%) and 26 (48.1%) women did not. Altogether, 25% of patients had improvement in renal function after insertion of PCN and in 10.3% renal function worsened. Some 50% of these patients received palliative radiotherapy, 7% started therapeutic chemoradiation and 7% of patients completed treatment. Response to treatment was unknown for 21% of patients, 7% showed partial response and 10.7% died of their disease. In the control group, 15.4% of patients had severe renal failure; 7.7% of patients never started treatment and 7.7% received palliative radiotherapy; 11.5% died of their disease. Some 26.9% of patients without PCN fell in the renal failure group, of whom 19.2% received palliative radiotherapy. Conclusion: PCN in patients with cervical cancer and obstructive uropathy, even if HIV positive, is safe with minimal complications. An improvement in renal function was shown after insertion. PCN improved the number of patients qualifying for initiation and completion of treatment.