Ways HIV infection and cervical cancer are linked

At HIV-infected women, the risk of developing cervical cancer is six times higher, according to an analysis of data from women on four continents. The regions of South and East Africa are particularly hard hit.

Bayern Munich. Women infected with HIV are 6 times more likely to develop cervical cancer. This is what researchers at the Technical University of Munich (TUM) have now found out (The Lancet Global Health 2020: online November 16).

According to the WHO, cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide, and around 311,000 women died of the disease, recalls TUM in a statement accompanying the publication of the study.

However, cervical cancer is also the most commonly recognized cancer in HIV-infected women, as the infection has weakened their immune systems.

Study shows link between cervical cancer and HIV infection

A research team from the Technical University of Munich (TUM) quantified the effects of human immunodeficiency virus (HIV) infection on the development of cervical cancer and found that women infected with HIV are six times more likely to develop cervical cancer get sick. The regions of South and East Africa are particularly hard hit.

According to WHO statistics, cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570,000 women worldwide were diagnosed with cervical cancer, and approximately 311,000 women died from the disease.

On the other hand, cervical cancer, which is mostly caused by the human papillomavirus (HPV), is also one of the most successfully preventable and treatable types of cancer, provided it is recognized early and effectively treated.

Cervical cancer is also the most commonly discovered cancer in women living with HIV because their immune systems are weakened by the HIV infection.

The Center for Global Health of the Faculty of Medicine and the Chair of Epidemiology of the Faculty of Sports and Health Sciences have now addressed this relevant topic in the publication “Estimates of the Global Burden of Cervical Cancer Associated with HIV” in the renowned specialist journal The Lancet Global Health dedicated.

Systematic review and meta-analysis of 24 studies

The first authors Dr. Dominik Stelzle (Center for Global Health and Chair for Epidemiology) and Dr. Luana Tanaka (Chair of Epidemiology) carried out a systematic review and meta-analysis of a total of 24 studies from 1981 to 2016 in which 236,127 women with HIV from four continents (Africa, North America, Asia and Europe) took part.

In total, these studies included 2,138 cervical cancer cases. In addition, the results were combined with data from UNAIDS on worldwide HIV infection and with data from the International Agency for Research on Cancer (IARC), the cancer research center of the WHO, on cervical cancer and evaluated.

“So far there have only been estimates from countries with a high net income,” says Dr. Stilt. “That was why we looked at the global cervical cancer-related burden figures for HIV infection, including estimates for countries with low net incomes. In most parts of the world, these numbers are below five percent. In some countries, however, we are talking about well over 40 percent of the cases. “

Women with HIV are six times more at risk

The aim of the study was to calculate the proportion of women living with HIV among women with cervical cancer. The authors found that 5.8 percent of all new cervical cancer cases worldwide in 2018 were diagnosed in women with HIV infection. This corresponds to 33,000 cases per year, 85 percent of which occur in sub-Saharan Africa.

On the basis of the results, the team was also able to show that women with HIV are six times more likely to develop cervical cancer than women without HIV infection.

“The association between cervical cancer and HIV is obvious,” explains Prof. Dr. Dr. Andrea S. Winkler, Co-Head of the Center for Global Health. “Cervical carcinomas are mostly caused by infections with human papillomavirus (HPV), which, like HIV, are sexually transmitted. Based on our results, one could assume that infection with HIV is a risk factor for infection with HPV. “

South and East Africa are hardest hit

The regions of South and East Africa are hardest hit, with 63.8 percent (South Africa) and 27.4 percent (East Africa) of cervical cancers diagnosed in women with HIV infection.

“At over 75 percent, Eswatini is the country in southern Africa with the highest proportion of women suffering from cervical cancer associated with an HIV infection, followed by Lesotho with 69 percent, Botswana with 67 percent, South Africa with 64 percent and Zimbabwe with 52 percent, “says Dr. Tanaka.

Based on the results, the TUM authors found that women with HIV infection have a significantly higher risk of developing cervical cancer. HPV vaccinations and early cervical cancer screenings are therefore of great importance, especially for the African countries south of the Sahara.

“In Africa there are already cervical cancer screenings, but so far mainly for women who have a higher socio-economic status and can therefore afford it financially,” says Prof. Dr. Stefanie Klug, holder of the chair for epidemiology at the Technical University of Munich. “The aim must be to break this dependency on economic possibilities and to achieve that the HPV vaccination for girls and the screening for women are free.”

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