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Cited by 13Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Cervical Cancer Screening in HIV-Positive Women in India: Why, When and How?

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Boddu, Amulya, Bhatla, Neerja, Vashist, Shachi, Mathur, Sandeep, Mahey, Reeta, Natarajan, Jayashree, Malik, Ria, Vanamail, Perumal +4 more·2021·The Journal of Obstetrics and Gynecology of India
DOI 10.1007/s13224-020-01419-0PMC PMC8310826
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Abstract

Background Cervical cancer is an AIDS-defining illness, and HIV-positive women are at high risk. The present study aimed to determine the magnitude of the problem, compare the performance of screening tests and assess factors affecting participation. Methods HIV-positive women aged 30-59 years attend the anti-retroviral therapy (ART) clinics were screened by conventional Pap, HPV testing (Hybrid Capture 2) and visual inspection with acetic acid (VIA). A cohort of HIV-negative women from the community matched for age and parity were screened similarly. Screen-positive women underwent colposcopy and biopsy. Factors affecting participation were assessed. Results Pap, VIA and HPV were positive in 48 (23.8%), 65 (32.2%) and 76 (37.6%) subjects, respectively, among HIV-positive women, and in 12 (5.9%), 10 (4.9%) and 12 (5.9%) subjects, respectively, among HIV-negative women. CIN2 + was present in 12 (6.4%) HIV-positive women and in 1(0.5%) HIV-negative woman (p = < 0.004). Sensitivity of HPV, Pap and VIA for detection of CIN2 + lesions was 91.7%, 75.0% and 75.0%, respectively; specificity was 68.4%, 83.9% and 72.5%, respectively. Lack of availability of screening facilities in the ART clinic and long waiting times were a strong deterrent to participation among HIV-positive women. Conclusions There was higher prevalence of HPV infection and CIN2 + lesions in HIV-positive women. VIA showed equivalent sensitivity to Pap and could be a good substitute in low resource settings. Setting up cervical screening services in ART clinics and sensitising physicians can improve outcomes among these women.

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  • In a cohort of 1128 WLHIV, HPV testing achieved a sensitivity of 94.5% for detecting LSIL or worse, outperforming VIA (83.6%) and Pap smear (63.3%).

    “In a cohort of 1128 WLHIV, HPV testing achieved a sensitivity of 94.5% for detecting LSIL or worse, outperforming VIA (83.6%) and Pap smear (63.3%).”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [21]

    The Results (Table 4; page unavailable) report sensitivities for detecting CIN2+ in HIV-positive women of 91.7% for HPV and 75.0% for both VIA and Pap smear—not the claimed values or VIA outperforming Pap. Another Results passage states that the study included 202 HIV-positive subjects, not a cohort of 1,128. The paper does not report these figures for LSIL or worse. (LLM, conf=0.90)

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  • HPV testing has high sensitivity for detecting precancerous lesions in WLHIV and inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology.

    “The rationale for this choice lies in HPV testing’s high sensitivity for detecting precancerous lesions in WLHIV and its inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology [19–23].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [21]

    The Results report that HPV testing detected CIN2+ lesions in HIV-positive women with 91.7% sensitivity, versus 75.0% for both Pap smear and VIA. The Materials and Methods describe a numerical threshold for a positive HPV test, but the paper does not establish that HPV testing is more objective or reproducible than VIA or cytology. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In India, hrHPV prevalence exceeds 20% and HSIL+ lesions occur in over 5% of screened WLHIV.

    “Our findings align with prior studies in India, reporting hrHPV prevalence exceeding 20% and HSIL+ lesions in over 5% of screened WLHIV [21, 24, 26].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [21]

    The Results report hrHPV in 37.6% of screened HIV-positive women, supporting the first figure. They report HSIL cytology in 4.5%, not over 5%; the 6.4% figure is for histologically diagnosed CIN2+ lesions, a different measure. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Pap smear showed the highest specificity (94.5%) in that cohort.

    “Although Pap smear showed the highest specificity (94.5%), it missed a substantial proportion of HSIL+ lesions, emphasizing the clinical advantage of HPV testing in this population [21, 22, 24, 25, 27].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [21]

    The Results (Table 4) and Discussion say Pap smear had the highest specificity among the screening tests, but report it as 83.9%, not 94.5%. In Table 4, 94.5% is the upper bound of the Pap smear sensitivity confidence interval. (LLM, conf=0.94)

    Experimental — accuracy not yet measured

  • HPV testing demonstrates superior sensitivity in detecting high-grade cervical lesions among WLHIV.

    “HPV testing demonstrates superior sensitivity in detecting high-grade cervical lesions among women living with HIV (WLHIV).”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [21]

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Research works printed but not linked: 17

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Authors
Boddu, A., Bhatla, N., Vashist, S., Mathur, S., Mahey, R., Natarajan, J., Malik, R., Vanamail, P., Rai, S., Kumari, A., Dar, L., & Wig, N.
Affiliations
All India Institute of Medical Sciences (IN)
Corresponding author
Bhatla, Neerja
ORCID
Venue
The Journal of Obstetrics and Gynecology of India
Publisher
Springer Science and Business Media LLC
Published
2021-02-19
Volume
71
Issue
3
Pages
304-312
ISSN
  • 0971-9202 (ISSN-L)
  • 0975-6434
DOI
10.1007/s13224-020-01419-0
PMC
PMC8310826
OpenAlex
W3130036972
Cited by
13
References
1
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2022: 2
FWCI
1.08
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Obstetrics and Gynecology of India (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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, women living with HIV, HPV infection, cervical intraepithelial neoplasia, Pap smear, visual inspection with acetic acid, Hybrid Capture 2, screening sensitivity and specificity, barriers to screening, antiretroviral therapy clinics, resource-limited settings, India

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