Today as WHO launches the Global Strategy to Accelerate the Elimination of Cervical Cancer, the first estimates of the contribution of HIV to the global cervical cancer burden are also being released.
Women living with HIV have a six-fold increased risk of cervical cancer when compared to women without HIV. This higher risk is manifested throughout the lifecycle starting with an increased risk of acquiring human papilloma virus infection (HPV), more rapid progression to cancer, lower chances of regression of pre-cancer lesions, higher rates of recurrence following treatment.
Worldwide, an estimated 5% of all cervical cancer cases are attributable to HIV. However, these statistics vary enormously by world regions. In areas with high HIV prevalence, the fraction of cervical cancer attributable to HIV is high and is ?40% in eight countries, compared to <5% in 127 countries with lower HIV prevalence. This contributes to the stark disparities in cervical cancer burden. Eighty-five percent of women with cervical cancer and HIV live in sub-Saharan Africa, underscoring the major contribution of HIV to the cervical cancer burden in the region. HPV vaccination, screening and treatment for cervical pre-cancer and cancer, which are critical to preventing and managing cervical cancer are yet to be fully scaled up, contributing to the greater burden.
We must now redouble our efforts and work towards achieving the new WHO cervical cancer elimination targets of 90% HPV vaccination coverage, 70% screening coverage, and 90% access to treatment for cervical pre-cancer and cancer, including access to palliative care by 2030. Achieving these targets could reduce more than 40% of new cervical cancer cases and 5 million related deaths by 2050.
“We have made great progress in expanding HIV treatment for all who need it. We now need to ensure that women living with HIV lives are not cut short by cervical cancer, an entirely preventable condition through vaccination, screening and treatment. On this launch of the Cervical Cancer Elimination Initiative, we recommit to ensuring women, implementing partners and ministries of health have the tools needed to implement our updated guidelines” said Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis, and STI Programmes.
Bringing together a public health approach with comprehensive, woman-centred care can help girls and women living with HIV and at risk of HPV infection, live long, healthy lives. Engaging the community of women in advocating for their care, providing choice and improving access to vaccination for girls and screening and treatment for women is critical. In the words of WHO Assistant Director-General Dr Princess Nothemba (Nono) Simelela, “As the world comes together to pledge to eliminate cervical cancer, we must keep our eye on ending this preventable burden on women and girls who are living with HIV. It is our unfinished business”
Population attributable fraction of women with cervical cancer living with HIV, 2018
Women living with HIV have a six-fold increased risk of cervical cancer when compared to women without HIV. In areas with high HIV prevalence, the fraction of cervical cancer attributable to HIV is high and is ?40% in eight countries, compared to <5% in 127 countries with lower HIV prevalence. This contributes to the stark disparities seen in the global cervical cancer burden associated with HIV.