A comprehensive systematic review published in the European Medical Journal has identified a marked age-related increase in cervical pre-cancer among women living with HIV. The findings, drawn from data across seven countries — Burkina Faso, Cameroon, India, Kenya, South Africa, Thailand and the United States — reinforce concerns about the compounded vulnerability faced by this population and are informing international public health guidance.
Elevated Risk Linked to Advancing Age
The review analysed more than 72,000 women, including over 12,500 living with HIV. Using pooled statistical modelling, researchers assessed the probability of developing cervical intraepithelial neoplasia (CIN), a pre-cancerous change in cervical cells classified in grades 2 and 3 as clinically significant.
The analysis demonstrated that risk increases progressively with age among women living with HIV. While adolescents aged 15 to 19 showed comparatively lower predicted rates of high-grade lesions, prevalence rose sharply in women in their twenties and continued to climb through midlife. The highest estimated probability of advanced pre-cancerous lesions was observed in women aged 45 to 49.
By contrast, invasive cervical cancer remained uncommon before the age of 30, suggesting a window of opportunity for timely detection and intervention.
HIV, HPV and Cervical Disease
Women living with HIV are known to have a heightened susceptibility to persistent infection with high-risk strains of human papillomavirus (HPV), the principal cause of cervical cancer. Immunosuppression associated with HIV may reduce the body’s capacity to clear HPV infections, thereby increasing the likelihood of cellular abnormalities progressing to high-grade lesions.
Peer-reviewed studies published in journals such as The Lancet HIV and the British Medical Journal have consistently reported higher recurrence rates of HPV infection and cervical abnormalities in women with HIV compared with HIV-negative populations. Antiretroviral therapy has improved life expectancy substantially, yet long-term cancer prevention remains a critical component of comprehensive HIV care.
Influence on Global Health Strategy
The findings of the review contributed to updated screening recommendations from the World Health Organization. Current guidance advises that women living with HIV should begin cervical cancer screening at 25 years of age, followed by repeat testing at intervals of three to five years, depending on national protocols and available resources.
In 2020, WHO Director-General Tedros Adhanom Ghebreyesus launched a global initiative to eliminate cervical cancer as a public health problem. The strategy established 2030 targets that include vaccinating 90 per cent of girls against HPV by the age of 15, screening 70 per cent of women by ages 35 and 45 using high-performance tests, and ensuring that 90 per cent of women diagnosed with cervical disease receive appropriate treatment.
Implications for National Health Systems
For countries included in the analysis — particularly those in sub-Saharan Africa, where HIV prevalence remains high — integrating cervical screening within HIV services is considered essential. Strengthening access to HPV vaccination, expanding laboratory capacity for high-accuracy screening tests, and ensuring follow-up care are central to reducing preventable mortality.
The evidence underscores that cervical cancer prevention cannot be separated from broader HIV care strategies. As women living with HIV experience longer lifespans due to advances in treatment, age-sensitive cancer screening policies will play a decisive role in safeguarding long-term health outcomes.