HIV-positive women are more at risk of recurrent cervical cancer

Among women living with HIV, more often than among HIV-negative, there are cases of residual or recurring events after treatment of precancerous lesions of the cervix, it follows from the work published in January in Clinical Infectious Diseases.

A systematic review and meta-analysis presented in the journal showed that the treatment of cervical intraepithelial neoplasia (CIN) or pathologies that could lead to progression to cancer, almost three times more often caused HIV-positive women to fail.

However, the authors of the study did not propose a classification of PLHIV based on the number of CD4 cells and did not draw parallels between the risk of oncology recurrence and ARVT, therefore, according to experts, the work cannot be considered complete.

Several types of human papillomavirus (HPV) can cause cervical cancer, anal and other types of cancer. Cervical cancer is the leading cause of cancer death for women worldwide, but in industrialized countries, due to regular screening for HPV and pap tests that allow early treatment, it is usually not among the leading causes of death.

Studies have shown that women living with HIV, more often than HIV-negative, have persistent HPV infection, leading to the development of CIN and invasive cervical cancer. However, women with lower CD4 levels have a higher risk of disease.

CIN lesions are classified by severity. Many lesions of the 1st level pass on their own. Treatment is usually recommended for women with precancerous lesions of grade 2 or 3 (also known as high-grade squamous intraepithelial lesions or HSIL).

Treatment may include the destruction of abnormal cells by cryotherapy or heating, or by electrosurgical intervention (LEEP).

Pierre Debodrap from the University of Paris Descartes and his colleagues conducted a systematic review and meta-analysis of studies on the results of the treatment of precancerous cervical diseases in women with HIV.

In evaluating MEDLINE, abstracts of HIV reports, and other sources in any language from January 1980 to May 2018, researchers identified 40 suitable studies where HIV-infected women with confirmed cervical disorders were observed for at least six months after treatment. Four were clinical trials, 16 were cohort studies and 20 were retrospective.

Two thirds of the work was done in high-income countries (mostly in the USA) and 13 in low- and middle-income countries (mainly in Africa). However, low-income country studies were larger and comprised the majority of the total number of participants. A total of 3975 HIV-positive women took part in the research. Some of the studies also included HIV-negative women in the comparison groups (a total of 3638 people). The most common treatment was LEEP.

A meta-analysis of the data showed that a significant prevalence of low treatment efficacy among HIV-positive women, defined as the persistent presence of residual CIN grade 2 or higher, or relapses of high CIN levels after treatment, was 21.4%. Half of the women had residual or recurrent cervical abnormalities of any degree.

Scientists did not identify differences in assessing the likelihood of failure in treatment with cryotherapy (13.9%) compared with LEEP (13.8%).

It should be noted that the failure rate for treatment was higher in high-income countries (27.9%) compared with poor countries (14.4%).

In 10 studies in which both HIV-positive and HIV-negative women took part, PLHIV had a more than twofold risk of not achieving treatment goals with a grade 2 or higher CIN (23.4% vs. 9.5%, respectively). In addition, HIV + women were five times more likely to develop cervical cancer after treatment of any degree.

“This meta-analysis suggests that even after the screening and treatment of the cervix of a woman, HIV-positive patients are still at high risk of CIN2 + / HSIL,” the researchers write.

“In the context of growing efforts to scale up screening for cervical cancer in under-resourced settings, these results highlight the importance of thinking about appropriate postoperative monitoring of this population.”