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Precancerous cervical lesions affect 22.25% of women living with HIV in Southern and Eastern AfricaRisk Factors Linked to Cervical Lesions in Women with HIV

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Key Takeaway
Note that smoking, multiparity, and lack of antiretroviral therapy are significantly associated with increased risk of PCCL.

This meta-analysis evaluates the prevalence of precancerous cervical lesions (PCCL) and associated risk factors among 47,009 women living with HIV in Southern and Eastern Africa. The study identifies a pooled prevalence of PCCL of 22.25% (95% CI: 19.57, 24.93).

Several factors were significantly associated with an increased risk of PCCL. These include smoking (OR = 7.01; 95% CI: 3.39, 14.49), multiparity (OR = 4.97; 95% CI: 3.21, 7.69), and a history of sexually transmitted infections (OR = 3.93; 95% CI: 3.23, 4.78). Other identified risk factors include having multiple sexual partners (OR = 3.06; 95% CI: 2.45, 3.83), early sexual debut under age 18 (OR = 2.99; 95% CI: 2.34, 3.82), oral contraceptive use (OR = 2.69; 95% CI: 1.85, 3.90), low CD4 count (OR = 1.79; 95% CI: 1.56, 2.05), and not having initiated antiretroviral therapy (OR = 2.02; 95% CI: 1.56, 2.62).

The findings suggest that clinical management of women living with HIV in these regions should consider these specific risk factors. However, the results are based on odds ratios and do not establish direct causation. No specific limitations were reported in the source data.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the specific risk factors for precancerous cervical lesions among women living with HIV in Southern and Eastern Africa. While prior evidence highlights the potential of mHealth interventions for cervical cancer control in Africa, this study identifies specific clinical and behavioral risk factors, such as smoking and lack of antiretroviral therapy, that may inform targeted screening and intervention strategies.

A large-scale review of data from over 47,000 women living with HIV in Southern and Eastern Africa looked at the prevalence of precancerous cervical lesions. The study found that about 22.25% of the women in this group had these lesions.

Researchers identified several specific factors associated with a higher risk of developing these lesions. These included smoking, having multiple sexual partners, a history of sexually transmitted infections, and having children. Other factors linked to higher risk included starting sexual activity before age 18, using oral contraceptives, having a low CD4 count, and not yet starting antiretroviral therapy.

It is important to note that these findings show links between certain behaviors and health risks, but they do not prove that one factor directly causes the other. Because this is a large-scale review of existing data, the results provide a broad look at trends in specific regions. Patients should speak with their healthcare provider to discuss these risk factors and develop a personalized prevention plan.

What this means for you:
Several factors, including smoking and certain health markers, are linked to higher cervical lesion risks in women with HIV.

Common questions

What specific factors increase the risk of cervical lesions?

The study found several factors linked to an increased risk of precancerous cervical lesions. These include smoking, having multiple sexual partners, a history of sexually transmitted infections, and having children. Other factors include starting sexual activity before age 18, using oral contraceptives, having a low CD4 count, and not starting antiretroviral therapy.

How common are precancerous cervical lesions in this group?

The study found a pooled prevalence of 22.25% for precancerous cervical lesions among the women living with HIV who were included in the analysis.

Does not starting antiretroviral therapy increase risk?

The data showed that not initiating antiretroviral therapy was associated with an increased risk of precancerous cervical lesions. Patients should talk to their doctor about the best treatment plan for their specific health needs.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up216.0 mo
PublishedJan 2026
View Original Abstract ↓
BACKGROUND: Women living with HIV (WLHIV) face a sixfold increased risk of cervical cancer compared to HIV-negative women. Most WLHIV residing in the Southern and Eastern African regions have a substantial HIV-related cervical cancer burden. Studies on precancerous cervical lesions (PCCL) and associated factors in WLHIV from these regions have inconsistent and inconclusive findings. Therefore, we aimed to synthesize the pooled prevalence of PCCL and associated factors among WLHIV in Southern and Eastern Africa. METHODS: This study was registered under PROSPERO (CRD420251123583) and conducted in accordance with PRISMA 2020 standards. Primary studies published from inception to 2025 in Southern and Eastern Africa were included. The methodological quality of studies was assessed using the Newcastle-Ottawa scale. Data extraction and statistical analyses were done in Microsoft Excel and STATA 17, respectively. Pooled prevalence, publication bias, subgroup, and sensitivity analysis were conducted. Associations were expressed as odds ratios (OR), and a p-value of less than 0.05 was considered statistically significant. RESULTS: 44 studies met the inclusion criteria, with a sample size of 47,009. The pooled prevalence of PCCL was 22.25% (95% CI: 19.57, 24.93). Age at first sexual intercourse (< 18 years) (OR = 2.99, (2.34, 3.82)), multiparity (OR = 4.97, (3.21, 7.69)), having multiple sexual partners (OR = 3.06 (2.45, 3.83)), having a history of sexually transmitted infections (STI) (OR = 3.93 (3.23, 4.78)), smoking (OR = 7.01, (3.39, 14.49)), ever taking oral contraceptive pills (OR = 2.69, (1.85, 3.90)), low CD4 count (OR = 1.79, (1.56, 2.05)), and having not initiated antiretroviral therapy (ART) (OR = 2.02, (1.56, 2.62)) were significantly associated with an increased risk of PCCL. CONCLUSION AND RECOMMENDATIONS: The pooled prevalence of PCCL was high. Additionally, early first sexual intercourse, parity, STIs, multiple sexual partners, smoking, oral contraceptive use, CD4 count, and ART were positively associated with the occurrence of PCCL. Therefore, stakeholders shall implement interventions to avert future incidents of PCCL and address the identified factors.
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