TOPLINE:

Among women with HIV infection, both lower CD4 counts and higher HIV RNA viral load were associated with higher incidence rates of moderate and severe cervical dysplasia, carcinoma in situ, and invasive cervical cancer; the positive association between HIV RNA viral load and precancer and cancer rates largely attenuated after adjustment for CD4 count.

METHODOLOGY:

• Researchers analyzed medical claims data from South Africa’s national HIV disease management program to examine whether earlier and recent measures of CD4 counts, and HIV RNA viral load were associated with the incidence of cervical precancer and invasive cervical cancer.
• The analysis included 66,920 women with HIV infection (median age, 34.8 years) enrolled in the program between January 2011 and December 2022 and assessed four outcomes based on International Classification of Diseases, 10th Revision (ICD-10) codes: moderate cervical dysplasia, severe cervical dysplasia, cervical carcinoma in situ, and cervical cancer.
• They used Cox proportional hazards models to assess associations of CD4 counts and HIV RNA viral load with these outcomes; the models were adjusted for age, calendar year, and antiretroviral therapy (ART) initiation.

TAKEAWAY:

• Incidence rates per 100,000 person-years were 394 (95% CI, 372-417) for moderate cervical dysplasia, 405 (95% CI, 383-428) for severe cervical dysplasia, 66 (95% CI, 58-76) for cervical carcinoma in situ, and 70 (95% CI, 61-79) for cervical cancer.
• Among women with HIV infection, those with lower CD4 counts (< 50 cells/μL) had a nearly fivefold higher risk for cervical carcinoma in situ (adjusted hazard ratio [aHR], 4.84; 95% CI, 2.40-9.79) and a more than fivefold higher risk for cervical cancer (aHR, 5.38; 95% CI, 2.54-11.43) than those with higher CD4 counts (≥ 500 cells/μL).
• The lowest CD4 count within 30 months was associated with a higher risk for moderate cervical dysplasia (aHR, 2.53; 95% CI, 1.86-3.43) and severe cervical dysplasia (aHR, 2.67; 95% CI, 1.96-3.62).
• Higher HIV RNA viral load categories (< 50; 50-999; 1000-99,999; and > 100,000 copies/mL) showed positive associations with precancer and cancer rates in models unadjusted for CD4 count, but these associations were attenuated after adjustment for CD4 count.

IN PRACTICE:

“Sustaining high CD4 counts through early ART initiation and effective HIV management, combined with the use of CD4 counts for risk stratification in cervical screening, may help improve cervical cancer prevention among WWH [women with HIV infection] in South Africa,” the authors wrote.

SOURCE:

The study was led by Yann Ruffieux, University of Bern, Bern, Switzerland. It was published online on February 14, 2026, in Clinical Infectious Diseases.

LIMITATIONS:

The data were derived from a private HIV disease management program, and therefore, the study may not have been generalizable to women with HIV infection in South Africa’s public sector. Outcome ascertainment relied on ICD-10 codes from insurance claims, which are prone to misclassification and lack the granularity of full histopathology reports. The study lacked information on important behavioral and clinical covariates including dates of ART initiation, human papillomavirus vaccination, and cervical screening, which are known to influence the risk for cervical cancer and could have confounded some of the observed associations.

DISCLOSURES:

This study was supported by various institutions and foundations including the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the National Cancer Institute, the Swiss National Science Foundation, and the Swiss Cancer Research foundation. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.