Cervical Cancer Screening Methods among Women Living with Human Immunodeficiency Virus: A Systematic Review and Meta-analysis
Summary
Background:
The efficacy of antiretroviral therapy diminishes without addressing comorbidities, particularly the heightened incidence and mortality of cervical cancer among women with human immunodeficiency virus (HIV).
Objectives:
This systematic review and meta-analysis aimed to evaluate different cervical cancer screening methods for women living with HIV, given the scarcity of evidence.
Materials and Methods:
Systematic searches of electronic databases yielded relevant original research published before August 2019, with additional studies identified through cross-referencing.
Results:
In a pooled analysis, visual inspection with Lugol’s iodine (VILI) demonstrated superior sensitivity, specificity, and accuracy (0.89, 0.88, and 0.88, respectively) compared to cytology testing (0.67, 0.79, and 0.77). VILI outperformed visual inspection with acetic acid (VIA) by 22% in sensitivity and 11% in specificity. Cytology lagged behind VILI by 22% in sensitivity and 9% in specificity. Human papillomavirus (HPV) DNA testing showed a 3% lower sensitivity and 2% lower specificity than VILI. Sequential VIA and cytology testing exhibited lower sensitivity for cervical intraepithelial neoplasia (CIN) 2 + detection than VILI and HPV testing, resulting in more missed cases. HPV testing, in combination with other modalities (VIA, VILI, and cytology), maximized the possibility of CIN2 + detection.
Conclusion:
VILI as a standalone test meets criteria for good sensitivity, specificity, and accuracy. The choice of screening modality should consider factors such as cost, geographical location, population type, professional training, and laboratory capacity.