Doctoral defence: Anna Tisler "HPV-related cancers among people living with HIV and transition towards risk-based prevention"

On June 6th Anna Tisler will defend her thesis "HPV-related cancers among people living with HIV and transition towards risk-based prevention".

Supervisor:
Professor Anneli Uusküla, University of Tartu

Opponent:
Miriam Elfström, Karolinska Institutet (Sweden)

Summary
The Silent Epidemic of HIV, HPV, and the challenge of cancer prevention
Antiretroviral therapy (ART) has transformed HIV from a fatal condition into a manageable chronic disease, allowing millions of people living with HIV (PLWH) to live longer and healthier lives. However, this progress has brought new challenges. Cancer has become a leading cause of illness and death among PLWH, highlighting the urgent need for preventive measures.

Elevated cancer risks in PLWH
PLWH are at a significantly higher risk of developing certain cancers, such as non-Hodgkin’s lymphoma, Kaposi’s sarcoma, and cervical cancer. This increased risk is due to immune suppression caused by HIV, along with behavioral factors, co-infections, and chronic inflammation. Human papillomavirus (HPV), a major cause of several cancers, worsens this situation. In 2018, HPV was responsible for 690,000 cancer cases globally, including cervical, anal, and oropharyngeal cancers.

Cervical cancer as preventable tragedy
Cervical cancer is largely preventable through vaccination and regular screening, but for women living with HIV (WLWH), the risks are heightened. Despite screening programs, only 14% of WLWH are covered longitudinally by organized cervical cancer screenings. Barriers such as stigma, lack of insurance, and co-existing health conditions hinder access to preventive measures.

The need for personalized screening
Eastern Europe, including Estonia, faces a dual health challenge: high HIV prevalence and insufficient cancer prevention efforts. Estonia has about 11,000 people living with HIV, 36% of whom are women, yet cervical cancer prevention remains inadequate, with coverage under 60% among general population. No guidelines are in place to specifically address the needs of WLWH. Traditional screening often fails to address the specific needs of WLWH. A "one-size-fits-all" approach overlooks the unique risk factors of this group. Personalized, risk-based strategies are needed, informed by factors like HIV status and prior cervical lesions. Predictive models based on real-world health data can help optimize screening while reducing overdiagnosis and false positives. Tailored interventions, co-created with input from PLWH, could improve screening rates. These may include community outreach, efforts to reduce stigma in healthcare settings, and self-sampling options. Collaboration between policymakers, researchers, and healthcare providers is essential to ensuring no one is left behind in the fight against HIV and cancer.