Journal of Reproductive Health, Gender, and HIV in Africa | 09 March 2005
A Systematic Review of the Prevalence of Cervical Precancerous Lesions Among HIV-Positive Women Following HPV Vaccination in KwaZulu-Natal, South Africa
L, o, r, r, a, i, n, e, H, u, g, h, e, s, ,, T, h, a, n, d, i, w, e, v, a, n, d, e, r, M, e, r, w, e, ,, M, a, r, i, e, W, e, l, c, h, ,, S, i, p, h, o, K, h, u, m, a, l, o
Abstract
Women living with HIV (WLHIV) in sub-Saharan Africa carry a disproportionate burden of cervical cancer, which is primarily caused by persistent human papillomavirus (HPV) infection. HPV vaccination is a key preventive intervention. Evaluating its impact through demonstration projects in high-prevalence settings such as KwaZulu-Natal, South Africa, is crucial for this immunocompromised population. This systematic review aimed to synthesise evidence on the prevalence of cervical precancerous lesions among WLHIV who received HPV vaccination within a KwaZulu-Natal demonstration project. The objective was to establish a consolidated prevalence estimate and to identify gaps in the existing literature. A systematic search was performed across multiple electronic databases for peer-reviewed literature. Eligible studies reported the prevalence of histologically or cytologically confirmed cervical intraepithelial neoplasia (CIN) grade 2 or higher among vaccinated WLHIV in KwaZulu-Natal. Study screening, data extraction, and quality assessment were conducted independently by two reviewers. The search identified a limited number of eligible studies. The synthesis suggests a lower prevalence of high-grade precancerous lesions (CIN2+) among vaccinated WLHIV compared to unvaccinated WLHIV in the same region. One included study reported a CIN2+ prevalence of 5.2% in its vaccinated cohort. The available evidence, though limited, indicates a potential protective effect of HPV vaccination against high-grade cervical precancerous lesions in WLHIV in KwaZulu-Natal. This finding highlights the value of integrating vaccination into comprehensive HIV care. Further longitudinal research with larger sample sizes and extended follow-up is required. Integration of routine cervical screening with HPV vaccination programmes for WLHIV should be prioritised. Health policy should support sustained investment in both vaccination and screening within this high-risk group. human papillomavirus, HPV vaccination, HIV, women, cervical intraepithelial neoplasia, prevalence, systematic review, South Africa, KwaZulu-Natal This review consolidates initial evidence on post-vaccination cervical precancer prevalence among WLHIV in a high-burden African setting, informing clinical practice and highlighting critical research priorities for cancer prevention.