Evelyn Yayra Bonney

Cervical Cancer in Women With HIV: A Call to Action for Equitable Prevention in Low‐ and Middle‐Income Countries

Cervical cancer is preventable; however, it remains the leading cause of death in low‐ and middle‐income countries (LMICs). Women with HIV (WWHs) have a sixfold higher risk of developing and dying from cervical cancer than women without HIV. Cervical cancer can be prevented by vaccination against high‐risk human papillomaviruses (hrHPVs) and by screening for and treating precancer cervical lesions. While these preventive measures are routinely available to WWHs in developed countries, they are lacking in most LMICs, where the burden of HIV and cervical cancer is the highest. To prevent cervical cancer deaths among WWHs in LMICs, it is imperative to determine the dual burden of HIV and cervical cancer in LMICs. This narrative review synthesized scientific papers and policy documents on the intersection of HIV and cervical cancer in LMICs published between August 2006 and July 2025. We searched PubMed, Scopus, Web of Science, and Google Scholar for articles and official reports from the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) on cervical cancer burden, prevention strategies, barriers, and outcomes among WWHs. Despite its proven effectiveness, HPV vaccination coverage in LMICs is under 30%, and screening uptake is below 20%. Weak health systems, workforce shortages, stigma, reliance on donor funding, and late‐stage case presentation are major challenges in curbing cervical cancer in LMICs. Urgent political commitment is required to integrate precancer screening and HPV testing into routine HIV care and scale‐up HPV vaccination to achieve the WHO′s triple‐intervention targets to eliminate cervical cancer among WWHs in LMICs.

Prevalence and risk factors associated with high-risk human papillomavirus infection among women living with HIV (WLWH) at a tertiary health facility in Accra, Ghana

Background Women living with HIV (WLWH) have high risk of developing cervical cancer. High- risk Human papillomavirus (hrHPV) is the single most important cause of cervical cancer. Vaccination for and early detection of pre-malignant cervical changes, through cervical cancer screening contributes to prevention of cervical cancer. This study sought to determine the prevalence of HPV among WLWH, genotypes present and the risk factors associated with cervical cancer development. Methods and findings An analytical cross-sectional study of 250 sexually active women aged 18 years and above, attending HIV clinic at a tertiary health facility in Accra. Demographic data collection and risk factor assessments were done using interviewer-administered questionnaire, and patient records. Cervical swabs were collected and tested for HPV using real-time PCR assays. Genotype analysis was performed on 92 samples. Descriptive statistics and logistic regression analysis were used to establish associations between hrHPV and risk factors among WLWH. Approximately 60% of study participants tested positive for HPV. The prevalence of hr-HPV among WLH was 44.4%. Factors identified to be protective of hrHPV were employment (AOR = 0.19, 95% CI = 0.06, 0.56, p = 0.003) and highly active antiretroviral therapy (HAART) Tenofovir-Lamivudine-Ritonavir-Lopinavir (TLRL) (AOR = 0.30, 95% CI = 0.09, 0.95, p = 0.04). Women with HIV diagnosis within 6 to10 years (AOR = 4.89, 95% CI = 1.05, 22.70, p = 0.043) and diagnosis >10 years (AOR = 8.25, 95% CI = 1.24, 54.84, p = 0.029) had higher odds of hrHPV. Approximately 25% of samples analysed tested positive for hr-HPV group 1 (genotypes 16, 18, 31, 33, 35, 39, 45,51, 52, 56, 58, 69) and 46.8% for multiple HPV genotypes. Conclusion A high prevalence of genotypes that include high risk genotypes 16 and 18 and multiple HPV infections was found among WLWH. Almost half of the women screened had high-risk HPV and were prone to cervical cancer without their knowledge. Regular HPV screening is recommended for high-risk patient groups.