Incidence of cervical intraepithelial neoplasia in women infected with human immunodeficiency virus (HIV) with no evidence of disease at baseline: Results of a prospective cohort study with up to 6.4 years of follow‐up from India
Open accessAbstract
We report the incidence of cervical intraepithelial neoplasia (CIN) among HIV‐infected women who did not have any colposcopic or histopathological evidence of CIN at baseline. Of the 1,023 women without any CIN at baseline, 855 (83.6%) have been followed up to a maximum of 6.4 years contributing 2,875 person years of observation (PYO). Among these 855 women, 54 cases of any CIN were observed resulting in incidence rate of any CIN of 1.9 per 100 PYO. The median time for follow‐up for women with any CIN was 3.0 (IQR 1.6–3.7) years. The cumulative incidence rate per 100 PYO of CIN 2 or worse lesion in women with HPV‐18 infection at baseline was 13.3% (95% CI 5.1–26.8); in women with HPV‐16 infection was 10.8% (95% CI 4.4–20.9); in women with HPV‐31 infection was 4.2% (95% CI 0.9–11.7); and in women with other high‐risk HPV infections was 5.4% (95% CI 2.6–9.7). HPV‐18 infection at baseline contributed highest frequency of incident CIN 2 or worse lesions followed by HPV‐16 infection; however, other high‐risk HPV types were also responsible for substantial number of incident CIN. The elevated risk of CIN2+ disease in the study cohort was non‐significant in women with CD4 count <200, possibly because of the small number of cases. Our results emphasize the need for regular cervical cancer screening of HIV‐infected women and urgent implementation of cervical cancer screening services in HIV programs in India and other low and middle‐income countries.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
HPV-positive WLHIV who did not have histological evidence of CIN at baseline have a substantial risk of incident HSIL.
“Studies have shown a substantial risk of incident HSIL among HPV-positive WLHIV who did not have histological evidence of CIN at baseline, further supporting the rationale for immediate treatment to prevent future disease [28, 29].”
From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [28]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
No references could be resolved yet.
Research works printed but not linked: 28
- Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
- Bray F, Ren JS, Masuyer E, et al. Global estimates of cancer prevalence for 27 sites in the adult pop- ulation in 2008. Int J Cancer 2013;132:1133-45.
- Patrelli TS, Gizzo S, Peri F, et al. Impact of highly active antiretroviral therapy on the natural history of cervical precancerous lesions: a 17-year institu- tional longitudinal cohort study. Reprod Sci 2014; 21:837-45.
- Blitz S, Baxter J, Raboud J, et al. Evaluation of HIV and highly active antiretroviral therapy on the natural history of human papillomavirus infection and cervical cytopathologic findings in HIV-positive and high-risk HIV-negative women. J Infect Dis 2013;208(3):454-62.
- Denslow SA, Rositch AF, Firnhaber C, et al. Incidence and progression of cervical lesions in women with HIV: a systematic global review. Int J STD AIDS 2014;25:163-77.
- Engels EA, Biggar RJ, Hall HI, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer 2008; 123(1):187-94.
- Chin-Hong PV, Husnik M, Cranston RD, et al. Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS 2009;23:1135-42.
- Lissouba P, Van de Perre P, Auvert B. Associa- tion of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis. Sex Transm Infect 2013;89: 350-6.
- Strickler HD, Burk RD, Fazzari M, et al. Natural history and possible reactivation of human papil- lomavirus in human immunodeficiency virus- positive women. J Natl Cancer Inst 2005;97: 577-86.
- Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12-9.
- Denny LA, Franceschi S, de Sanjosé S, et al. Human papillomavirus, human immunode- ficiency virus and immunosuppression. Vaccine 2012;30(Suppl 5):F168-74. 1090 Incidence of CIN in HIV-infected women Int. J. Cancer: 144, 1082-1091 (2019) © 2018 UICC Infectious Causes of Cancer 10970215, 2019, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ijc.31826, Wiley Online Library on [30/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
- 1993 Revised classification system for HIV infec- tion and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992;41:1-19.
- Clifford GM, Goncalves MA, Franceschi S. Human papillomavirus types among women infected with HIV: a meta-analysis. AIDS 2006;20:2337-44.
- De Vuyst H, Lillo F, Broutet N, et al. HIV, human papillomavirus, and cervical neoplasia and cancer in the era of highly active antiretroviral therapy. Eur J Cancer Prev 2008;17:545-54.
- Parham GP, Mwanahamuntu MH, Kapambwe S, et al. Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zam- bia. PLoS One 2015;10:e0122169.
- Joshi S, Sankaranarayanan R, Muwonge R, et al. Screening of cervical neoplasia in HIV- infected women in India. AIDS 2013;27:607-15.
- Firnhaber C, Goeieman B, Faesen M, et al. Prospective one year follow up of HIV infected women screened for cervical cancer using visual inspection with acetic acid, cytology and human papillomavirus testing in Johannes- burg South Africa. PLoS One 2016;11(1): e0144905.
- Joshi S, Babu JM, Jayalakshmi D, et al. Human papillomavirus infection among human immuno- deficiency virus-infected women in Maharashtra, India. Vaccine 2014;32:1079-85.
- Khan MJ, Castle PE, Lorincz AT, et al. The ele- vated 10-year risk of cervical precancer and can- cer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type- specific HPV testing in clinical practice. J Natl Cancer Inst 2005;97:1072-9.
- Bulliard JL, Sasieni P, Klabunde C, et al. Methodological issues in international com- parison of interval breast cancers. Int J Cancer 2006;119:1158-63.
- Bennett RL, Sellars SJ, Moss SM. Interval cancers in the NHS breast cancer screening programme in England, Wales and Northern Ireland. Br J Cancer 2011;104:571-7.
- Warren R, Duffy S. Interval cancers as an indica- tor of performance in breast screening. Breast Cancer 2000;7:9-18.
- Massad LS, Xie X, D'Souza G, et al. Incidence of cervical precancers among HIV-seropositive women. Am J Obstet Gynecol 2015;212:606-8.
- Thorsteinsson K, Ladelund S, Jensen-Fangel S, et al. Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population. HIV Med 2016;17:7-17.
- Joshi S, Kulkarni V, Gangakhedkar R, et al. Are we missing opportunities to prevent cervical can- cer in HIV-infected women in India? Indian J Med Res 2015;142:610-3.
- Kelly H, Weiss HA, Benavente Y, et al. Association of antiretroviral therapy with high-risk human papillomavirus, cervical intrae- pithelial neoplasia, and invasive cervical cancer in women living with HIV: A systematic review and meta-analysis. Lancet HIV 2018;5:e45-58.
- Huh WK, Ault KA, Chelmow D, et al. Use of pri- mary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guid- ance. Gynecol Oncol 2015;136:178-82.
- Miranda D. Screening still the "best buy" for tack- ling cervical cancer. Bull World Health Organ 2011;89:628-9.
Cited by
Sorted by citations
Rao, S., R, S., Sarma, D., Nath, A., R, A., Jagannathan, L., Rao, A., Suhas, G., Iyengar, S., V, R., et al. (2025) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2025.26.12.4513
“For this socio-economically disadvantaged population, travelling long distances involves lost wages and travel expenditures, [28, 29].”
- Authors
- Joshi, S., Muwonge, R., Kulkarni, V., Deodhar, K., Mandolkar, M., Lucas, E., & Sankaranarayanan, R.
- Affiliations
- Department of Preventive Oncology Prayas and HCJMRI Pune India
- Centre international de recherche sur le cancer (FR)
- Prayas Pune India
- Tata Memorial Hospital (IN)
- RTI International (US)
- Corresponding author
- Sankaranarayanan, Rengaswamy
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2018-11-20
- Volume
- 144
- Issue
- 5
- Pages
- 1082-1091
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W2888630678
- Cited by
- 10
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Funders
- UICC Cervical Cancer Initiative Seed Grant, Maharashtra Foundation, USA, Emcure, Ranbaxy, Sun Pharma, Serum Institute of India and Cipla Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Keywords
- cervical intraepithelial neoplasia, HIV infection, incidence, human papillomavirus, HPV16, HPV 18, high-risk HPV, women living with HIV, CD4 count, cervical cancer screening, low- and middle-income countries
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Colposcopy, Female, Follow-Up Studies, Humans, India, Middle Aged, Risk Factors, Vaginal Smears, Cohort Studies, Incidence, CD4 Lymphocyte Count, Papillomaviridae, Papillomavirus Infections, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
