Abstract:
BACKGROUND : There 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 HIVseropositive
women in developing countries. This paper did not review the issue of human papillomavirus (HPV)
prophylactic vaccine on HIV-seropositive women.
METHODS : Five 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.
RESULTS : Due 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.
CONCLUSION : Although cervical cancer screening exists in almost all developing countries, what is missing is both
