Abstract:
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.
