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

In 30 seconds

This systematic review and meta-analysis pooled evidence on precancerous cervical lesions (PCCL) and associated factors among women living with HIV in Southern and Eastern Africa. It included 44 studies with 47,009 participants. The pooled PCCL prevalence was 22.25% (95% CI: 19.57, 24.93). Several factors were associated with higher odds of PCCL, including smoking, multiparity, a history of sexually transmitted infections, and sexual debut before age 18. These pooled associations identify groups and factors relevant to prevention, but do not establish causation.

Key findings

• Pooled PCCL prevalence was 22.25% (95% CI: 19.57, 24.93) across 44 studies.
• Smoking was associated with higher odds of PCCL (OR = 7.01, (3.39, 14.49)); multiparity was also associated (OR = 4.97, (3.21, 7.69)).
• History of sexually transmitted infections was associated with PCCL (OR = 3.93 (3.23, 4.78)), as was first sexual intercourse before age 18 (OR = 2.99, (2.34, 3.82)).
• Low CD4 count (OR = 1.79, (1.56, 2.05)) and not having initiated ART (OR = 2.02, (1.56, 2.62)) were associated with increased odds of PCCL.

Why it matters

The pooled estimate indicates a substantial burden of precancerous cervical lesions among women living with HIV in these regions. The reported associations can help frame prevention and screening priorities and highlight the relevance of sexual health and HIV-related factors. Because the findings synthesize associations from primary studies, they should inform risk assessment rather than be interpreted as proof that any factor causes lesions.

What to keep in mind

The meta-analysis combines primary studies with potentially differing populations and methods; the abstract does not report study-level heterogeneity or establish causal relationships.