Background:  Previous research has shown that HIV⁺ women are at a higher risk of developing high-grade pre-invasive cervical intraepithelial neoplasia (CIN2/3) than their HIV^– counterparts. The influence of HIV on the development of invasive cervical cancer is controversial.

Methods:  In 2006, a “see-and-treat” cervical cancer prevention program was established in Lusaka, Zambia. Patients with cervical lesions that were complex or suspicious for invasive cervical cancer underwent histopathologic evaluation. We evaluated the association between HIV status and histopathological diagnoses using logistic regression.

Results:  The mean age of all women (n = 922) with baseline information and histology was 34 years; 75.8% were HIV⁺. Using logistic regression and after controlling for age and number of lifetime partners, it was found that HIV⁺ women had greater odds of being diagnosed with CIN2/3 (OR 1.634, 95%CI 1.091 to 2.447) than HIV^– women. It was also found that HIV⁺ women had lower odds of being diagnosed with invasive cervical cancer (OR 0.370, 95%CI 0.197 to 0.695) than HIV^– women. After controlling for age and lifetime sexual partners, the association between HIV and CIN2/3 remained significant (OR 1.664, 95%CI 1.066 to 2.6), while the association between HIV and invasive cervical cancer became insignificant (OR 0.858, 95%CI 0.544 to 1.354).

Conclusions:  HIV⁺ women in Zambia are more likely to be diagnosed with CIN2/3, but are less likely to be diagnosed with invasive cervical cancer. The relationship between HIV and pre-invasive cervical intraepithelial neoplasia (CIN 2/3) is well-documented and is thought to be due to HIV-induced modulation of the immune response to human papillomavirus (HPV). The association between HIV and CIN2/3 was not explained by number of sexual partners. The association between HIV and invasive cervical cancer could be due to the limited role of the immune system in the progression of CIN2/3 to invasive cervical cancer. Progression to invasive cancer may instead reflect irreversible genetic damage that has occurred in the cervical lesions. Alternatively, our findings may reflect that HIV⁺ women are dying from other AIDS-related illnesses before developing invasive cervical cancer. Studies have suggested that as women in resource-constrained environments, like Zambia, continue to gain access to ART and live longer, their risk for developing cervical cancer will increase. This underscores the importance of routine cervical cancer screening in women receiving HIV care and treatment.