Prevention of cervical cancer in HIV-seropositive women from developing countries through cervical cancer screening: a systematic review

Abstract

BackgroundThere is scanty or inconclusive evidence on which cervical cancer screening tool is effective and suitable for human immunodeficiency virus (HIV)-seropositive women. The aim of this review was to assess, synthesise and document published evidence relating to the available cervical cancer screening modalities for HIV-seropositive women in developing countries. This paper did not review the issue of human papillomavirus (HPV) prophylactic vaccine on HIV-seropositive women.MethodsFive electronic databases were systematically searched from inception to January 2018 for relevant published original research examining cervical cancer prevention modalities for HPV infection, abnormal cytology and direct visualisation of the cervix amongst HIV-seropositive women in developing countries. Extra studies were identified through reference list and citation tracking.ResultsDue to methodological and clinical heterogeneity, a narrative synthesis was presented. Of the 2559 articles, 149 underwent full-text screening and 25 were included in the review. Included studies were of moderate quality, and no exclusions were made based on quality or bias. There is no standard cervical cancer screening test or programme for HIV-seropositive women and countries screening according to available resources and expertise. The screening methods used for HIV-seropositive women are the same for HIV-negative women, with varying clinical performance and accuracy. The main cervical cancer screening methods described for HIV-seropositive women are HPV deoxyribonucleic acid/messenger RNA (DNA/mRNA) testing (n = 16, 64.0%), visual inspection with acetic acid (VIA) (n = 13, 52.0%) and Pap smear (n = 11, 44.0%). HPV testing has a better accuracy/efficiency than other methods with a sensitivity of 80.0–97.0% and specificity of 51.0–78.0%. Sequential screening using VIA or visual inspection with Lugol’s iodine (VILI) and HPV testing has shown better clinical performance in screening HIV-seropositive women.ConclusionAlthough cervical cancer screening exists in almost all developing countries, what is missing is both opportunistic and systematic organised population-based screenings. Cervical cancer screening programmes need to be integrated into already existing HIV services to enable early detection and treatment. There is a need to offer opportunistic and coordinated screening programmes that are provider-initiated to promote early identification of cervical precancerous lesions.Systematic review registrationPROSPERO CRD42018095702Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0874-7) contains supplementary material, which is available to authorized users.

High-risk human papillomavirus prevalence in self-collected cervicovaginal specimens from human immunodeficiency virus (HIV)-negative women and women living with HIV living in Botswana

“…The HPV prevalence in WLWH reported in this study was lower than observed in some populations [16][17][18][19][20][21][22], comparable to some populations [18;23-26], and higher than in other populations [18;27] living in SSA. We observed, as seen in other studies, that HIV status [24;27] was an independent predictors of HPV prevalence in WLWH.…”

Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study

“…Thus, our findings may suggest in part that sex-specific mortality differences do not reflect inherently better health behaviors among women compared to men, but rather access to reproductive health services and earlier HIV care entry among younger women, and a lack of similar benefit among older women who do not access such services [4,13]. It is well-established that HIV-positive women are at increased risk for the development of cervical cancer [71]. Cervical cancer is the most commonly diagnosed cancer among women in Zambia, with the highest proportion of registered cases concentrated among those 40-60 years old [72].…”

“…Cervical cancer is the most commonly diagnosed cancer among women in Zambia, with the highest proportion of registered cases concentrated among those 40-60 years old [72]. While data regarding cervical cancer were not available as part of our study, it is possible that delayed and missed diagnoses of cervical cancer may have also contributed to the high mortality rate observed among older women, and, therefore, continued scale-up and availability of screening [71] coupled with early ART and retention in HIV services [73] might be an important intervention to address mortality among older HIV-positive women. We also observed that less than 30% of women �50 years old were married (with more than 30% reporting being widowed), a marked difference from the nearly two-thirds of men �50 years old reporting being married.…”

Selecting human papillomavirus genotypes to optimize the performance of screening tests among South African women

“…3,5,8 Although advantageous in many regards, HPV DNA testing has the trade-off of having relatively low specificity, 7,[9][10][11] particularly in women living with HIV. 5,12 In the screen-and-treat model, now widely recommended as the most appropriate approach for low-resource settings, the relatively low specificity of HPV DNA testing means that sizable numbers of women may be overtreated for transient infections that will ultimately regress. 13 Scarce resources would be unnecessarily spent on women at low risk for CIN2+ being referred for further colposcopy follow-up or treatment.…”