| Shrnutí: | Cervical cancer is common amongst human immunodeficiency virus (HIV)-positive women in
low- and middle-income countries. In South Africa, more than 7500 cases are diagnosed annually
and over 50% result in death, making cervical cancer the leading cause of cancer mortality.1
South
Africa’s high HIV prevalence contributes to this high burden, because HIV-positive women are
more likely to have persistent human papilloma virus (HPV) infection and precancerous cervical
changes.2
Cervical cancer is preventable either through HPV vaccination of girls before sexual
debut, which was rolled out in South Africa from 2014, or screening and treatment of precancerous
cervical lesions. South African guidelines recommend cervical screening for all HIV-positive
women at HIV diagnosis and then every 3 years.1
Antiretroviral therapy (ART) causes immune reconstitution and may reduce the risk of cervical
cancer amongst HIV-positive women by lowering HPV acquisition, increasing HPV clearance
and slowing the progression to precancerous lesions.2
However, these effects may be diminished
for women who initiate ART at low CD4 counts.3
Since 2016, when universal test and treat (UTT)
was introduced in South Africa, women began initiating ART at CD4 counts > 500 cells/mm3
(early initiators) and may therefore be protected against precancerous cervical abnormalities and
cancer.3
In this study, we aimed to assess whether early initiators of ART had a lower risk of abnormal
cervical smears when compared to late initiators (women with a CD4 ≤ 500 cells/mm3
), after
introduction of UTT in South Africa.
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