BACKGROUND : Cervical cancer has become a major public health challenge in developing countries with a reported
age-standardised incidence rate of about 17.9/100,000/year and lifetime risks approaching 1 in 20 in some settings.
Evidence indicates that HIV-seropositive women are 2 to 12 times more likely to develop precancerous lesions that
lead to cervical cancer than HIV-negative women. There is a lack of rigorous evidence on which treatment methods
are being utilised for HIV-positive women, and this review aims to synthesise available evidence on treatment
modalities for both cervical neoplasia and cervical cancer in HIV-seropositive women in developing countries.
METHODS : A systematic review guided by a published protocol was conducted. Online databases including
MEDLINE/PubMed, Embase, CINAHL and Emerald (via EBSCOhost), PsycINFO, Cochrane Library, and health
databases, which cover developing countries (3ie Systematic Reviews, WHO library and databases, World Bank
website), were searched for published articles. Additional articles were found through citation, reference list
tracking, and grey literature. Study design, treatment category, geographic country/region, and key outcomes for
each included article were documented and summarised.
RESULTS : Thirteen research articles from sub-Saharan Africa, Asia, and South America were included. Eight (61.5%)
articles focused on the treatment of cervical cancer with the remaining five (38.5%) assessed cervical neoplasia
treatment. The available cervical cancer treatments, radiotherapy, chemotherapy, chemoradiation, and surgery are
effective for HIV-seropositive patients, and these are the same treatments for HIV-negative patients. Both
cryotherapy and LEEP are effective in reducing CIN2+ among HIV-seropositive women, and a choice between the
treatments might be based on available resources and expertise. Radiation, chemotherapy, concurrent treatment
using radiotherapy and chemotherapy, and surgery have shown the possibility of effectiveness among HIVseropositive
women. Cervical cancer stage, immunosuppressive level including those on HAART, and multisystem
toxicities due to treatment are associated with treatment completion, prognostic, and survival outcomes.
CONCLUSIONS : Treatment of cervical cancer is based on the stage of cancer, and poor outcomes in most developing
countries might be due to a lack of optimal treatment regimen. Those infected with HIV were younger and had
advanced cervical cancer as compared to those who were HIV-negative. Facilitation and putting HIV-infected
people on life-long ART is of importance and has been found to have a positive impact on cervical cancer
treatment response. Research on precancerous lesions and cervical cancer management of HIV-seropositive patients
focusing on the quality of life of those treated; the effectiveness of the treatment method considering CD4+ count
and ART is required.
Additional file 1. PubMed and OvidSP (MEDLINE and Embase) Search
Strategies. This file contains two examples of the search strategies used
to search for studies that were included in this literature review. The
search strategies are for PubMed, MEDLINE and Embase databases.
WM is a Public Health Specialist and Cancer Clinical Epidemiologist, and this study was part of his Ph.D. at the School of Health Systems and Public Health, University of Pretoria. WM’s research was focusing on cervical cancer and HIV in developing countries. (http://hdl.handle.net/2263/69905)