THERE is a clear, age-related increase in cervical intraepithelial neoplasia (CIN) among women living with HIV, a 2026 systematic review has found.
Those at highest risk of the precancerous change in the cervix were in 45-49-year-old women living with HIV.
Age of Women Living with HIV and Risk
Women living with HIV have an increased risk of cervical cancer and more recurrent human papillomavirus (HPV) infections compared with women without HIV.
Researchers conducted a systematic literature review using more than 300 sources from 1 January 2012 to 13 October 2019. Included articles reported original data and assessed at least one outcome related to cervical precancer and cancer in women living with HIV.
The review used data from more than 72,300 women from seven countries (Burkina Faso, Cameroon, India, Kenya, South Africa, Thailand, and the USA), more than 12,500 of whom were living with HIV.
They then used random-effects models to calculate predicted probabilities for cervical cancer screening results by age, HIV status, and antiretroviral therapy status.
In girls and women aged 15-19-years-old, the pooled predicted probability of CIN2 (grade 2 neoplasia) or CIN3 (grade 3) was approximately 6%. It jumped to around 32.4% in women living with HIV aged 20-24-years-old, then increased more steadily with age: approximately 42.1% in 25-29-year-olds, 50.,3% in 30-34-year-olds, 47% in 35-39-year-olds, 49% in 40-44-year-olds, 58.1% in 45-49-year-olds, and 55.3% in women 50 and above.
Invasive cervical cancer was uncommon before 30 years of age.
Informing WHO Recommendations
Researchers therefore found a clear, age-related increase in CIN2 and CIN3 among women living with HIV.
Findings informed recommendations to WHO that cervical cancer screening should be initiated for women living with HIV at 25 years, with regular screening every 3-5 years.
In November 2020, WHO Director-General Dr Tedros Adhanom Ghebreyesus launched a global strategy to accelerate the elimination of cervical cancer as a public health problem.
The launch set various targes for 2030: 90% of girls fully vaccinated with HPV vaccine by 15-years-old, 70% of women screened with a high-performance test by 35 -years-old and again by 45-years-old, and 90% of women identified with cervical disease receiving treatment.
References
Dalal S et al. Age-specific distribution of cervical precancer and cancer among women living with HIV across seven countries: a systematic review and an individual patient data meta-analysis. The Lancet HIV. 2026;13(2):E126-E137.
World Health Organization. New WHO recommendations on screening and treatment to prevent cervical cancer among women living with HIV. 2021. Available at: https://www.who.int/publications/i/item/9789240030961. Last accessed: 2 March 2026.
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