A more personalized approach to cervical cancer screening for women with HIV.

Abstract

Women living with HIV (WWH) have an increased risk of invasive cervical cancer due to persistent HPV infection and a weakened immune response. Regular cervical screening is recommended, but compliance is poor. This study aims to identify determinants associated with non-compliance and the risk of high-grade intraepithelial lesions (HSIL) in WWH. The study assessed compliance with the national cervical screening guideline of the Dutch Association of HIV Practitioners (NVHB) in Dutch WWH. Data from the ATHENA National HIV cohort, including WWH from seven HIV centers registered from 2000 through 2021, were analyzed. Descriptive and logistic regression analyses were performed to examine the associations between determinants and guideline adherence, as well as the associations between these determinants and cervical smear results in the study population. The study included 1537 WWH, of whom 1007 (65.5%) had at least one cervical smear, resulting in a compliance rate of 0.28 per three patient-years. Among these 1007 women, 228 (22.6%, 23 per 1,000 p-y) had HSIL and 9 (0.9%, 0.9 per 1,000 p-y) developed cervical cancer. Compliance was associated with hormonal contraceptive use, limited alcohol consumption, a history of STDs (other than HIV), and pregnancy. Non-compliance was more common in WWH born in Africa and Western Europe compared to those born in the Netherlands and in those never treated with cART. HSIL was associated with younger age, drug use, high-risk HPV, low CD4 counts, and detectable viral load. Cervical screening compliance in WWH in the Netherlands is moderate to poor, with HSIL incidence twice as high as in the general population. These findings underscore the importance of cervical screening in this high-risk group. The results can guide the development of personalized strategies to improve screening adherence, leading to earlier HSIL detection and a reduced cervical cancer incidence.