Great challenge, end cervical cancer in women with HIV

Mara Ruiz
Mara Ruiz

It is necessary to test cervical cancer every three years in women with HIV and to vaccinate against the Human Papilloma Virus (HPV) in the majority of girls with HIV if this type of cancer is to be eradicated in this population by the year 2130.

This was revealed by a study published in the scientific journal eClinical Medicine, which developed models of intervention scenarios in low- and middle-income countries, in which HIV has a high impact.

It should be remembered that there are already vaccines against HPV, which is the cause of almost all cases of cervical cancer, making it one of the few cancers preventable by immunization. This is why, in 2020, the World Health Organization called for the elimination of this public health problem, with a first deadline to be met in 2030.

Scenarios in the general population

The study, conducted by an international consortium, developed three models to assess the impact that prevention strategies and screening tests would have on the incidence of cervical cancer, as well as the time it would take to eliminate cervical cancer as a public health problem, explains the website.

The models used demographic data and the prevalence of HPV, HIV, and cervical cancer in South Africa. This country was chosen for its high prevalence of HIV and for the ease of accessing data from the national cancer screening program, which began in 2000. The results obtained with this model are applicable to other countries with similar circumstances.

The three models measured the impact of three HPV vaccination and cervical cancer screening scenarios in the general population:

1) Only vaccination of girls from 9 to 14 years old.

2) Vaccination of girls from 9 to 14 years of age plus a screening test for cervical cancer in all women who reach 35 years of age.

3) Vaccination of girls from 9 to 14 years of age plus two screening tests for cervical cancer in all women who turn 35 and 45 years of age.

The models demonstrated that these strategies would reduce the incidence of cervical cancer between 83 and 87% by the year 2120. However, in the short term, vaccination of girls plus two screening tests would achieve a greater reduction (49%) in the incidence in compared to vaccination alone (15%).

In addition, compared to vaccination as the only strategy, the second option would accelerate the goal of reducing the incidence of cancer by half by 18 years. With these figures, the elimination of the health problem could be achieved in 2093.

It should be noted that vaccination alone did not eliminate the problem in any of the models proposed.

Scenarios in women with HIV

The three models also compared the impact if these three scenarios were implemented for HIV-positive women and girls, in addition to the general population scenarios:

1) Vaccination of adolescent girls and young people from 15 to 24 years of age.

2) Cervical cancer screening every three years for women with HIV between the ages of 24 and 49.

3) Vaccination of young HIV-infected girls between the ages of 15 and 24 and cervical cancer screening tests every three years in HIV-infected women between the ages of 24 and 49

In women living with HIV, the strategy that was most effective in the general population (vaccination plus two screening tests) reduced cancer rates by 75-92% by 2120, but failed to eliminate this problem within the first 100 years.

However, adding more frequent screening (every three years) to the most effective model for the general population would reduce cancer incidence among HIV-positive women by 40% by 2045 and 27% by 2120.

This change also sped up the elimination of cancer in HIV-positive women by 10 to 20 years, but only if the less ambitious goal of reducing the problem by 85% was set, compared to the elimination goal set for the general population.

A major challenge

For the research team, eliminating this type of cancer in women living with HIV is a great challenge in South Africa and other countries with similar conditions, so high vaccination coverage and cancer detection tests every three years will be essential to achieve the goal.

Remember that both HIV and HPV are sexually transmitted infections from which a condom can protect you. If you want to obtain them for free, visit the offices of AHF Latin America and the Caribbean in your country and learn about all our services.