Burden of high-risk HPV, cervical precancer, and prevention gaps among women living with HIV in India
Seema Singhal, Pranay Tanwar, Saroj Rajan, Kirti Garg, Shahin Naz Jamali, Aarthi S. Jayraj, Neeraj Nischal, Sanjay Ranjan, Abhishek Bose, Jyoti Meena, Rajesh Kumari, Anju Singh, Nilanchali Singh, Sandeep Mathur, Neerja Bhatla, Neena MalhotraBackground and objectives
Women living with HIV (WLHIV) are at increased risk of persistent high-risk human papillomavirus (HPV) infection and cervical cancer, yet cervical cancer screening uptake remains low despite regular healthcare engagement. We assessed the prevalence of high-risk HPV infection among screen-eligible WLHIV, their knowledge and attitudes toward cervical cancer prevention, and completion of the screening-to-treatment pathway to evaluate the feasibility of integrating HPV DNA testing into routine HIV care.
Methods
We conducted a prospective observational study among 327 screen-eligible WLHIV attending an antiretroviral therapy (ART) clinic between June 2023 and 2025. Cervical samples were tested for HPV DNA using the Cobas 4800 assay. HPV-positive women underwent colposcopy and biopsy. Knowledge, attitudes, and practices related to cervical cancer prevention were assessed using a structured questionnaire. Multivariable logistic regression was used to identify factors associated with HPV positivity.
Results
High-risk HPV was detected in 74 women (22.6%), including HPV-16 in 39.2%, HPV-18 in 18.9%, and other oncogenic genotypes in 71.6%; 25% had overlapping infections. Cervical intraepithelial neoplasia (CIN) was identified in 16 women (21.6%), including 8 (11.4%) with high-grade squamous intraepithelial lesions and one case of invasive cervical cancer. A CD4 count ≥200 cells/mm 3 at antiretroviral therapy (ART) initiation was independently associated with lower odds of high-risk HPV positivity [adjusted odds ratio (OR) 0.51; 95% confidence interval (CI) 0.28–0.91; P =0.024]. Completion of the screening-to-treatment pathway was 98.2%. Knowledge of cervical cancer prevention was poor and did not differ between HPV-positive and HPV-negative women ( P =0.479).
Interpretation and conclusions
WLHIV remain at substantial risk of high-risk HPV infection and cervical precancer, particularly those with advanced immunosuppression at ART initiation. Integrating HPV DNA testing into routine ART clinic services resulted in high screening-to-treatment pathway completion.