Screening of cervical neoplasia in HIV-infected women in India
Abstract
Objective To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them. Design A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy. Methods We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated. Results : Among 1128 women screened, 55 (4.9%) had CIN2-3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2-3 based on preliminary results at 6-month to 1-year follow-up peri…
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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 [24]
The increased sensitivity of HPV testing for cervical precancerous lesions is due to earlier detection rather than overdiagnosis.
“The increased sensitivity of HPV testing for cervical precancerous lesions has been shown to be due to earlier detection rather than overdiagnosis [22–25].”
From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [24]
HPV testing has practical advantages such as limited training requirements and the potential for self-sampling that ease the burden on healthcare resources, making it suitable for resource-limited settings.
“Furthermore, practical advantages such as limited training requirements and the potential for self-sampling ease the burden on healthcare resources, making it suitable for resource-limited settings [22, 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 [24]
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 [24]
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 [24]
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 [24]
Tissue specimens were obtained from all treated women, allowing documentation of overtreatment.
“We were able to document the extent of overtreatment in our study because tissue specimens were obtained from all treated women [24, 31, 32].”
From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [24]
Pap smear missed a substantial proportion of HSIL+ lesions.
“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 [24]
The risk of HIV transmission after treatment is not significant in women on ART.
“The risk of HIV transmission after treatment is considered not significant in women on ART [24, 25, 27, 33–35].”
From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [24]
Cited by
Sorted by citations
Randall, T. C., Sauvaget, C., Muwonge, R., Trimble, E. L., & Jeronimo, J. (2019) · Preventive Medicine · doi:10.1016/j.ypmed.2018.10.006 · Cited by 88 · see citing works
Self-citationRao, 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
“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].”
Influential
- Authors
- Joshi, S., Sankaranarayanan, R., Muwonge, R., Kulkarni, V., Somanathan, T., & Divate, U.
- Affiliations
- Jehangir Hospital (IN)
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Sankaranarayanan, Rengaswamy
- Venue
- AIDS
- Published
- 2013-02-20
- Volume
- 27
- Issue
- 4
- Pages
- 607-615
- ISSN
- 0269-9370 (ISSN-L)
- OpenAlex
- W2089765690
- Cited by
- 89
- References
- 0
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 3 · 2022: 9 · 2021: 11 · 2020: 9 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 9 · 2015: 9 · 2014: 5 · 2013: 4
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- AIDS (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, cervical intraepithelial neoplasia, visual inspection with acetic acid, visual inspection with Lugol's iodine, HPV testing, cervical cytology, colposcopy, cold coagulation, resource-limited settings
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Colposcopy, Cost-Benefit Analysis, Cross-Sectional Studies, Coloring Agents, Feasibility Studies, Female, HIV Seropositivity, Humans, India, Iodides, Mass Screening, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Vaginal Smears, Acetic Acid, Papillomavirus Infections, Early Detection of Cancer
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