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The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study
Abstract
Cervical cancer is the leading cause of cancer death among women in Zambia, where widespread HIV infection elevates cervical cancer risk. However, HIV’s contribution to Zambia’s cervical cancer burden and the extent to which antiretroviral therapy (ART) has mitigated this burden, remain poorly quantified. We adapted HPVsim, an existing open-source mathematical model simulating human papillomavirus (HPV) and cervical cancer natural history, to capture the dual burden of cervical cancer and HIV in Zambian women. We extended HPVsim by incorporating country-specific HIV incidence data and modeled how HIV alters cervical disease progression through CD4 cell count-dependent modification of HPV susceptibility and disease severity. We calibrated the model to GLOBOCAN cervical cancer estimates and cervical cancer incidence rate ratios by HIV status estimated from the Zambian Cancer Registry. We estimated that by 2025, 49.9% of all cervical cancer cases in Zambia could be attributed to HIV co-infection. Although ART prevented at least an estimated 5.4% of cervical cancer cases nationally and 8.7% of cases among women with HIV, HIV remains a major driver of the cervical cancer burden. HIV-stratified prevention strategies will be essential for Zambia to achieve the World Health Organization’s cervical cancer elimination targets.
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Abbreviations
- ART:
-
Antiretroviral therapy
- DHS:
-
Demographic health survey
- GLOBOCAN:
-
Global Cancer Observatory
- HIV:
-
Human immunodeficiency virus
- HPV:
-
Human papillomavirus
- HPVsim:
-
Human papillomavirus simulator
- IQR:
-
Interquartile range
- IRR:
-
Incidence rate ratio
- LMICs:
-
Low- and middle-income countries
- UN:
-
United Nations
- UNAIDS:
-
Joint United Nations Programme on HIV/AIDS
- VIA:
-
Visual inspection with acetic acid
- WHO:
-
World Health Organization
Acknowledgements
This study was supported by the Swiss Cancer Research foundation (grant number KFS-5447-08-2021) and by the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Cancer Institute; the National Institute of Mental Health; the National Institute on Drug Abuse; the National Heart, Lung and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Diabetes and Digestive and Kidney Diseases; the Fogarty International Center under grant number U01AI069924.
Simulations and calibrations were performed on UBELIX (https://www.id.unibe.ch/hpc), the HPC cluster at the University of Bern, Switzerland.
Funding
Open access funding provided by University of Bern
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Competing interests
The authors declare no competing interests.
Supplementary Information
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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Andoh, J., Kapesa, H., Msadabwe, S.C. et al. The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-67046-3
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Source: Nature
https://www.nature.com/articles/s41598-026-67046-3
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