Precancerous Cervical Lesions Affect One in Five HIV-Positive Women in Southern and Eastern Africa

Roughly one in five women living with HIV in Southern and Eastern Africa has precancerous cervical lesions, according to a systematic review and meta-analysis that pooled data from 44 studies covering 47,009 women. The analysis, registered with PROSPERO (CRD420251123583) and conducted in accordance with PRISMA 2020 standards, found a pooled prevalence of precancerous cervical lesions of 22.25 percent (95% CI: 19.57 to 24.93). The authors describe this burden as high, and it is set against a well-documented background: women living with HIV face approximately a sixfold increased risk of cervical cancer compared with HIV-negative women, and the Southern and Eastern African regions carry a substantial share of HIV-related cervical disease.

The review included primary studies published from inception to 2025 in Southern and Eastern Africa, and the methodological quality of each study was assessed with the Newcastle-Ottawa scale. Data extraction and statistical analyses were performed in Microsoft Excel and STATA 17, respectively. Beyond the headline prevalence figure, the authors conducted pooled prevalence estimation, publication bias assessment, subgroup analysis, and sensitivity analysis to test the robustness of their results. Associations between potential risk factors and precancerous lesions were expressed as odds ratios, with a p-value below 0.05 considered statistically significant.

Eight factors emerged as significantly associated with an increased likelihood of precancerous cervical lesions. Smoking showed the strongest association, with an odds ratio of 7.01 (95% CI: 3.39 to 14.49), followed by multiparity at 4.97 (95% CI: 3.21 to 7.69) and a history of sexually transmitted infections at 3.93 (95% CI: 3.23 to 4.78). Having multiple sexual partners was associated with an odds ratio of 3.06 (95% CI: 2.45 to 3.83), and early sexual debut, defined as first sexual intercourse before age 18, carried an odds ratio of 2.99 (95% CI: 2.34 to 3.82). Ever taking oral contraceptive pills was associated with an odds ratio of 2.69 (95% CI: 1.85 to 3.90).

HIV-specific factors also played a measurable role. Women who had not initiated antiretroviral therapy had roughly twice the odds of precancerous lesions compared with those on treatment, with an odds ratio of 2.02 (95% CI: 1.56 to 2.62), while a low CD4 count was associated with an odds ratio of 1.79 (95% CI: 1.56 to 2.05). The authors conclude that the pooled prevalence of precancerous cervical lesions among women living with HIV in Southern and Eastern Africa is high, and they recommend that stakeholders implement interventions to avert future incidents of precancerous cervical lesions and address the identified factors.

As a synthesis of pooled studies, the meta-analysis identifies associations rather than proving causation, and the wide confidence interval around the smoking estimate reflects uncertainty in that pooled effect. The authors also note that previous studies on precancerous cervical lesions and associated factors among women living with HIV in these regions have produced inconsistent and inconclusive findings, which motivated the pooled synthesis. Even so, the consistency of the HIV-related signals, particularly low CD4 count and lack of antiretroviral therapy, alongside the reproductive and behavioral factors identified, gives researchers and health planners in the regions where the burden is greatest a clearer evidence base for targeting prevention efforts among women living with HIV.

Subject of Research: Pooled prevalence of precancerous cervical lesions and associated risk factors among women living with HIV in Southern and Eastern African countries

Article Title: Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis

Article References: Alemu, G. G., Bazezew, A. M., Yirsaw, A. N., Wondie, W. T., Mengistie, B. A., Dagnaw, T. E., Aweke, M. N., Baykemagn, N. D., Lakew, G., & Gebretsadkan, B. T. (2026). Precancerous cervical lesions and associated factors among HIV-positive women in Southern and Eastern African countries: A systematic review and meta-analysis. PLOS One, 21(10), e0361185. https://doi.org/10.1371/journal.pone.0361185

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0361185

Keywords: HIV, cervical cancer, precancerous cervical lesions, systematic review, meta-analysis, antiretroviral therapy, CD4 count, Southern Africa, Eastern Africa, women's health, Precancerous, cervical