Colorectal cancer screening uptake and lesion detection in people living with HIV : A systematic review and meta‐analysis

INTRODUCTION: As people living with HIV age, the absolute colorectal cancer (CRC) burden rises, yet the extent of routine CRC screening delivery and clinical yield is unclear. We synthesized evidence on screening uptake and lesion detection in people living with HIV, including comparisons with HIV-negative controls. METHODS: We searched PubMed, EMBASE and Cochrane CENTRAL through 8 November 2025. We included antiretroviral therapy-era studies of adults with HIV (mean/median age ≥50 years) reporting CRC screening uptake in routine care or pathology-confirmed lesions at screening lower endoscopy (colonoscopy/sigmoidoscopy). Random-effects restricted maximum likelihood (REML) meta-analyses pooled single-arm proportions and comparative risk ratios; sensitivity, influence and cumulative analyses were prespecified. RESULTS: Twenty-two studies were included. For screening uptake, 15 studies (people living with HIV n = 29 469) contributed single-arm estimates and 6 studies (people living with HIV n = 26 001; controls n = 858 658) contributed comparative data. Pooled uptake of screening among people living with HIV was 43% (95% confidence interval CI 36%-50%). Pooled detection of adenoma, villous/tubulovillous adenoma and CRC by screening lower endoscopy in people living with HIV was 27%, 3.8% and 1.4%, respectively. Screening uptake and lesion detection rates showed no significant difference from controls, though study numbers were limited and heterogeneous. CONCLUSION: In people living with HIV, CRC prevention is constrained by low and variable screening uptake. Screening lower endoscopy identifies clinically significant lesions, highlighting the need to improve CRC screening delivery in this population.