Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India
Open accessAbstract
We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow‐up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow‐up was 3.5 years (IQR 2.8‐4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person‐years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40‐661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30‐3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high‐grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high‐grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79‐89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long‐term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative.
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 [29]
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: 23
- Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203.
- Liu G, Sharma M, Tan N, Barnabas RV. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. Aids. 2018;32(6):795-808.
- García-Piñeres AJ, Hildesheim A, Herrero R, et al. Persistent human papillomavirus infection is associated with a generalized decrease in immune responsiveness in older women. Cancer Res. 2006;66(22): 11070-11076.
- Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021;9(2): e161-e169.
- van Sighem AI, Gras LA, Reiss P, Brinkman K, de Wolf F. ATHENA national observational cohort study. Life expectancy of recently diag- nosed asymptomatic HIV-infected patients approaches that of unin- fected individuals. Aids. 2010;24(10):1527-1535.
- Kelly H, Weiss HA, Benavente Y, de Sanjose S, Mayaud P, ART and HPV Review Group. Association of antiretroviral therapy with high- risk human papillomavirus, cervical intraepithelial neoplasia, and inva- sive cervical cancer in women living with HIV: a systematic review and meta-analysis. Lancet HIV. 2018;5(1):e45-e58.
- Zeier MD, Nachega JB, van der Merwe FH, et al. Impact of timing of antiretroviral therapy initiation on survival of cervical squamous intraepithelial lesions: a cohort analysis from South Africa. Int J STD AIDS. 2012;23(12):890-896.
- Massad LS, Fazzari MJ, Anastos K, et al. Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV. J Low Genit Tract Dis. 2007;11(2):90-97.
- Joshi S, Sankaranarayanan R, Muwonge R, Kulkarni V, Somanathan T, Divate U. Screening of cervical neoplasia in HIV-infected women in India. Aids. 2013;27(4):607-615.
- Joshi S, Babu JM, Jayalakshmi D, et al. Human papillomavirus infec- tion among human immunodeficiency virus-infected women in Maha- rashtra, India. Vaccine. 2014;32(9):1079-1085.
- Joshi S, Muwonge R, Kulkarni V, et al. Incidence of cervical intrae- pithelial neoplasia in women infected with human immunodeficiency virus (HIV) with no evidence of disease at baseline: results of a pro- spective cohort study with up to 6.4 years of follow-up from India. Int J Cancer. 2019;144(5):1082-1091.
- Joshi S, Mane A, Muwonge R, et al. Prevalence and predictors of bac- terial vaginosis in HIV-infected women in Maharashtra, India. Int J Std Aids. 2020;31(6):541-552.
- Richart RM. A modified terminology for cervical intraepithelial neo- plasia. Obstet Gynecol. 1990;75(1):131-133.
- Maglennon GA, Doorbar J. The biology of papillomavirus latency. Open Virol J. 2012;6:190-197.
- Gravitt PE, Winer RL. Natural history of HPV infection across the life- span: role of viral latency. Viruses. 2017;9(10):267.
- Looker KJ, Rönn MM, Brock PM, et al. Evidence of synergistic rela- tionships between HIV and human papillomavirus (HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status. J Int AIDS Soc. 2018;21(6):e25110.
- Tseng A, Seet J, Phillips EJ. The evolution of three decades of antire- troviral therapy: challenges, triumphs and the promise of the future. Br J Clin Pharmacol. 2015;79(2):182-194.
- Gottschlich A, van Niekerk D, Smith LW, et al. Assessing 10-year safety of a single negative HPV test for cervical cancer screening: evi- dence from FOCAL-DECADE cohort. Cancer Epidemiol Biomarkers Prev. 2021;30(1):22-29.
- Debeaudrap P, Sobngwi J, Tebeu PM, Clifford GM. Residual or recurrent precancerous lesions after treatment of cervical lesions in human immu- nodeficiency virus-infected women: a systematic review and meta- analysis of treatment failure. Clin Infect Dis. 2019;69(9):1555-1565.
- Atemnkeng N, Aji AD, de Sanjose S, Mayaud P, Kelly H. Antiretroviral therapy and detection of high-grade cervical intraepithelial neoplasia (CIN2+) at post-CIN management follow-up among women living with human immunodeficiency virus: a systematic review and meta- analysis. Clin Infect Dis. 2020;71(10):e540-e548.
- Greene SA, de Vuyst H, John-Stewart GC, et al. Effect of cryotherapy vs loop electrosurgical excision procedure on cervical disease recur- rence among women with HIV and high-grade cervical lesions in Kenya: a randomized clinical trial. JAMA. 2019;322(16):1570-1579.
- Pinder LF, Parham GP, Basu P, et al. Thermal ablation versus cryo- therapy or loop excision to treat women positive for cervical precan- cer on visual inspection with acetic acid test: pilot phase of a randomised controlled trial. Lancet Oncol. 2020;21(1):175-184.
- Mezei AK, Armstrong HL, Pedersen HN, et al. Cost-effectiveness of cervical cancer screening methods in low-and middle-income coun- tries: a systematic review. Int J Cancer. 2017;141(3):437-446.
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., Mandolkar, M., Lucas, E., Pujari, S., Sankaranarayanan, R., & Basu, P.
- Affiliations
- Prayas, Amrita Clinic Athawale Corner Pune India
- Centre international de recherche sur le cancer (FR)
- Institute of Infectious Diseases Pune India
- Corresponding author
- Basu, Partha
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2022-08-09
- Volume
- 152
- Issue
- 2
- Pages
- 249-258
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W4285794662
- Cited by
- 12
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2023: 1
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Cancer (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- cervical cancer screening, HPV testing, women living with HIV, cervical intraepithelial neoplasia, screening interval extension, persistent HPV infection, HPV clearance, thermal ablation, CIN regression, cervical cancer prevention, cervical cancer elimination
- MeSH terms
- Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Female, Humans, India, Cohort Studies, HIV Infections, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer
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
