More than one in five women living with HIV tested positive for high-risk human papillomavirus (HPV), a major cause of cervical cancer, in a study at AIIMS, New Delhi. But what was more worrying was that very few had previously undergone cervical cancer screening, highlighting the need to make cervical screening part of routine HIV care.
The study, published in the Indian Journal of Medical Research and titled "Burden of high-risk HPV, cervical precancer, and prevention gaps among women living with HIV in India", assessed 327 women attending the AIIMS clinic between June 2023 and June 2025. High-risk HPV was detected in 22.6% of participants. Among those who tested positive, 16 had cervical precancerous lesions, and one was diagnosed with invasive cervical cancer.
Yet only nine women in the entire study group — 2.8% — reported having undergone cervical cancer screening before. Just three women, or 0.9%, had received HPV vaccination.
The findings highlight the need to use routine HIV care as an opportunity to identify women at risk of cervical cancer and link them to screening and treatment.
HPV is the main cause of cervical cancer. While most infections clear on their own, persistent infection with high-risk types can lead to precancerous changes. Women living with HIV are more vulnerable because weakened immunity can make it harder to clear the virus and may increase the risk of persistent infection and disease progression.
The AIIMS study found that women who had a CD4 count of at least 200 cells/mm³ when they started ART had about half the odds of high-risk HPV infection compared with women who began treatment with lower counts. The association suggests that immune suppression at the start of HIV treatment may have lasting implications, even when immunity improves later.
Awareness was also strikingly low. Only 20.8% of participants had heard of cervical cancer, 17.4% knew that HPV causes it, and 5.2% were aware of any screening method. Fewer than one in eight knew that screening can detect precancerous changes.
However, attitudes were more encouraging. Nearly nine in 10 women supported regular screening for early detection, and 90.2% said they would be willing to undergo screening if services were accessible or free. This points to an opportunity to improve uptake through counselling and easier access, rather than relying only on women to seek screening independently.
The researchers tested cervical samples using an HPV DNA assay. Women who tested positive or had suspicious findings were referred for colposcopy and biopsy, followed by treatment where necessary. Overall, 98.2% completed the recommended screening-to-treatment pathway, indicating that the approach was feasible within the ART clinic setting.
Among women who tested positive, HPV-16 was detected in 39.2% and HPV-18 in 18.9%. Other high-risk types were also common, with some women carrying more than one type. The range of infections reinforces the importance of screening rather than relying on symptoms or awareness of a particular HPV type.
Most women in the study had no symptoms at screening. This is important because cervical precancer may not cause noticeable symptoms, and waiting for warning signs can delay detection. Screening can identify changes before they progress to cancer.
The researchers said ART clinics could serve as a practical platform for cervical cancer prevention because women already attend them regularly for medicines, monitoring and counselling. Integrating HPV testing into these visits could reduce the need for separate appointments and help ensure that women who test positive receive further evaluation and treatment.
The study was conducted at a single centre and did not assess long-term outcomes. Its findings may therefore not represent all women living with HIV in India. However, the results underline the importance of strengthening cervical cancer prevention within HIV care, rather than treating the two as separate health priorities.
The study was authored by Dr Seema Singhal, Dr Saroj Rajan, Dr Kirti Garg, Dr Shahin Naz Jamali, Dr Abhishek Bose, Dr Jyoti Meena, Dr Rajesh Kumari, Dr Anju Singh, Dr Nilanchali Singh, Dr Neerja Bhatla and Dr Neena Malhotra from the Department of Obstetrics and Gynaecology, AIIMS, New Delhi. At the same time, Dr Pranay Tanwar is from the Department of Onco-Haematopathology, Dr B R Ambedkar Institute-Rotary Cancer Hospital, AIIMS, New Delhi, while Dr Neeraj Nischal and Dr Sanjay Ranjan are from the Department of Medicine, AIIMS, New Delhi. Dr Sandeep Mathur is from the Department of Pathology, AIIMS, while author Dr Aarthi S. Jayraj is from the Department of Gynaecologic Oncology, National Cancer Institute, Jhajjar, Haryana.
