HIV, HPV and the limits of “screen-and-treat”: why extensive cervical lesions matter

Cervical cancer kills more African women than any other cancer, and women living with HIV are six times more likely to develop it. Low-resource settings increasingly rely on “screen-and-treat” programs that detect HPV and immediately offer simple ablative therapy — but that approach only works if the lesion is small enough to ablate. This analysis from the ACTG A5282 trial, conducted across seven countries, examined how often women living with HIV have lesions too extensive for ablation and therefore needing more specialised surgical treatment. Among over 1,000 women screened, 17% had lesions inappropriate for ablation, rising to 26% among those with high-risk HPV — and a third of those with extensive lesions had high-grade pre-cancer. The findings carry a clear programmatic message: screen-and-treat services for women living with HIV must have surgical (LEEP) capacity readily available, or they risk leaving the highest-risk women under-treated.