Estimates of the global burden of cervical cancer associated with HIV

Abstract

Summary 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.

RETRACTED ARTICLE: Knockdown of circRNA_0007534 suppresses the tumorigenesis of cervical cancer via miR-206/GREM1 axis

“…90% of deaths from CC are found in low-and middle-income countries (especially in the areas of high HIV prevalence) due to the scarcity of preventive opportunity and limitation of treatments [5]. The recent research has reported that CC burden has been increased in southern Africa and eastern Africa [6]. To seek therapeutic targets and explore the pathological mechanism may be beneficial for the diagnosis and treatment of CC patients.…”

Distribution of Human Papillomavirus (HPV) Genotypes in HIV-Negative and HIV-Positive Women with Cervical Intraepithelial Lesions in the Eastern Cape Province, South Africa

“…Cervical cancer is one of the three cancers established as AIDS-defining cancers [5]. South Africa ranked as the country with the fourth highest number of cervical cancer cases among HIV-positive women (63.4%) in 2018 [6]. The incidence rate of cervical cancer was estimated to be 506 per 10,000 person-years among HIV-positive South African women in 2017 [7].…”

B7 homolog 6 promotes the progression of cervical cancer

“…Cervical cancer is the fourth most common type of cancer diagnosed in women worldwide, accounting for >500,000 new cases and 311,365 deaths in 2018 (1). Despite cervical cancer being one of the more treatable malignant diseases, with multiple treatment strategies available, including surgical resection, radiation and chemotherapy, there are currently no effective targeted or immunotherapeutic approaches for patients with advanced cervical cancer (2,3).…”