Cervical Cancer and HIV
- Cervical cancer is preventable with the HPV vaccine, and it is curable if detected and treated early.
- Women living with HIV are more at risk of cervical cancer, and are up to six times more likely to develop cervical cancer than women who do not have HIV.
- Cervical Cancer is considered to be an AIDS-defining illness.
- Taking effective HIV treatment and increasing your CD4 count significantly lower your risk of developing cancer.
- It is recommended that women living with HIV have a cervical screening test every year.
What is Cervical Cancer and what causes it?
Cervical Cancer is caused by some strains of human papillomavirus (HPV), and develops in the cells of a woman’s cervix, which is the opening to the uterus at the top of the vagina (or the neck of the womb).
HPV is a very common sexually transmitted infection (STI), usually spread by genital skin-to-skin contact during sex. If you have ever had sex, you are likely to have come into contact with HPV.
How common is Cervical Cancer?
Cervical Cancer is the second most common type of cancer in women worldwide, and the most common cause of cancer-related deaths in the developing world.
Each year, more than 500,000 women will develop cervical cancer worldwide and over half of these women will die of the disease.
In Europe, around 60,000 women are diagnosed with cervical cancer each year, and 30,000 women die from the disease.
In Ireland, about 300 women are diagnosed with cervical cancer each year, and over 90 women die.
Most deaths from cervical cancer are preventable, particularly if detected early, highlighting the importance of regular screening.
The risks for women living with HIV
Women living with HIV are more at risk of cervical cancer, and are up to six times more likely to develop cervical cancer than women who do not have HIV. Cervical cancer is considered to be an AIDS-defining illness.
While HPV infections are very common in the general population and most women with healthy immune systems will clear these infections over time, women with compromised immune systems (such as women with HIV) are far less likely to clear an HPV infection. This means that once they have HPV, women living with HIV are more likely to develop pre-invasive lesions that can, if left untreated, quickly progress to invasive life-threatening cervical cancer.
The World Health Organisation (WHO) recommends cervical screening and providing adequate treatment to all women living with HIV as soon as they know their status.
The HPV Vaccine
Cervical cancer is preventable with the HPV vaccine.
In Ireland, the HPV vaccine is offered by the HSE school vaccination programme to all first year students in secondary school.
The National Immunisation Committee (NIAC) recommends the HPV vaccine for men and women living with HIV up to and including 26 years of age and for all gay and bisexual men, and men who have sex with men (gbMSM), including gbMSM living with HIV, up to and including 45 years of age.
The vaccine is available through many STI and HIV clinics. Ask a nurse or doctor at your clinic for more information.
Cervical cancer can take a long time to develop and often has no signs or symptoms. Regular screening is the only way to ensure that any abnormal cells in the cervix are detected early and treated early, thereby preventing the development of cervical cancer.
A cervical screening test checks the health of your cervix. During the screening test, a small sample of cells is taken from your cervix. The cervix is the opening to your womb from your vagina. It’s not a test for cancer, it’s a test to help prevent cancer from developing. The sample is first tested for human papillomavirus (HPV). HPV can cause abnormal cell changes in the cervix and is the main cause of cervical cancer. If HPV is found, your same test sample will be checked to see if you have any abnormal (or pre-cancerous) cells in your cervix.
This is a new way of screening. It is called HPV cervical screening and was introduced in Ireland in March 2020.
If you have had a smear test in the past, having a cervical screening test will feel the same.
In most cases, it takes 10 to 15 years for cells in the cervix to go from normal to pre-cancer to cancer. Finding HPV or abnormal cells early means you can be monitored or treated so they do not turn into cervical cancer.
You will generally get your results by letter, usually about 4 to 6 weeks after your screening test.
If abnormalities are detected, you will be referred for further investigation. All follow up tests, if required, are also free of charge.
CervicalCheck – Ireland’s National Cervical Screening Programme – provides free cervical screening tests to women aged 25 to 65 (with some exceptions).
Who should have cervical screening?
Women and people with a cervix between the age of 25 and 65 should go for regular cervical screening when it’s due:
25 to 29 years old – every 3 years
30 to 65 years old – every 5 years
It’s free of charge.
You can register with Cervical Check and/or check if you are already on the register.
Cervical Screening for Women living with HIV
An annual cervical screening test is recommended for women living with HIV.
If you have HIV, you will be invited for cervical screening every 12 months regardless of what age you are.
As women living with HIV are up to six times more likely to develop cervical cancer than women who do not have HIV, it’s important to be pro-active about this; don’t wait for a reminder. Talk to someone at your HIV clinic about annual screening if you are concerned
You should also have a cervical screening test within a year of your HIV diagnosis.
Trans men and cervical screening
If you are aged 25 to 65 and registered with welfare services as female, you should receive invitation letters for cervical screening. If you’re registered with welfare services as male, you will not receive invitation letters. You can still have cervical screening. Talk to your GP.
If you have had a hysterectomy
If you had a hysterectomy you may still need to have cervical screening tests. Talk to your GP who can advise you on the need for continued screening.
What can I do to reduce my risk of getting cancer?
As people with HIV are now living longer, there is an increased chance of developing cancers generally associated with older age which are not linked to having HIV.
Small changes to your lifestyle can help to reduce your risk of developing cancer – such as improving your diet, getting enough exercise, stopping smoking, cutting down on alcohol, staying at a healthy weight, and avoiding sun damage to your skin.
Make sure to take up routine testing such as screening for cervical, breast or bowel cancer. Starting antiretroviral treatment straight away can also be preventative. Keep taking your HIV treatment and keep your viral load undetectable.
Further information and reading:
HPV Vaccination Information Leaflet for Men and Women living with HIV (published by HSE)
HPV Vaccination Information Leaflet for MSM, including MSM living with HIV (published by HSE)
Cervical Cancer Elimination Initiative (World Health Organization)
Recommendations on screening and treatment to prevent cervical cancer among women living with HIV (World Health Organization)
Women with HIV have sixfold increase in risk of cervical cancer, aidsmap.com, 30 December 2020