Cervical Cancer in Women with HIV in A Setting with High Smoking: Implications for Prevention

Abstract

In China, cervical cancer is recognized as a major public health problem. Human papillomavirus (HPV) infections cause almost all cases of cervical cancer. Tobacco smoking and co-infection with human immunodeficiency virus (HIV) are two independent risk factors for cervical cancer. Women living with HIV (WLWH) have been shown to have higher risks of HPV infection, precancerous lesions, and cervical cancer. Similarly, smoking negatively impacts the immune system and increases the risk of cervical cancer. Routine cervical cancer screening followed by early treatment is effective in reducing the burden of cervical cancer. In 2009, the Chinese government launched a population-based cervical cancer screening program in rural China as the first step towards implementing national population-based cervical cancer screening. Cervical cancer incidence among Chinese WLWH is estimated to be 47.6 per 100,000, compared to 15.5 per 100,000 in the general population. Considering their excess risk of developing cervical cancer, current screening coverage remains low. Moreover, the current cervical cancer screening guidelines for China do not provide separate screening recommendations for WLWH to account for their increased risk. The aims of this dissertation are to provide evidence to support tailored cervical cancer screening programs for WLWH in Guangxi, a region with a high prevalence of HIV in China. Since smoking control is a challenge in China, and more than 70% of adults are exposed to secondhand smoke in a typical week, we specifically consider the additional risk of cervical cancer associated with smoking exposure. In particular, we (1) surveyed WLWH in Guangxi regarding their knowledge about cervical cancer screening and risk factors for cervical cancer, (2) systematically summarized the literature on the effect of smoking exposure on cervical abnormalities among WLWH, and (3) evaluated the benefits and the harms associated with cytology-based cervical cancer screening tailored to WLWH in Guangxi using decision modeling.