{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:07:14Z","timestamp":1789387634651,"version":"build-2803163510"},"reference-count":113,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Women living with HIV experience a disproportionate burden of persistent high-risk human papillomavirus infection and cervical cancer, yet they remain underrepresented in pivotal immunotherapy trials. Consequently, the effects of HIV-associated immune remodeling on the cervical cancer tumor immune microenvironment, biomarker interpretation, and response to immune checkpoint inhibition remain poorly defined. In this Review, we synthesize evidence concerning chronic inflammation, T-cell dysfunction and exhaustion, impaired antigen presentation, myeloid-mediated immunosuppression, and mucosal and microbial disruption in cervical cancer among women living with HIV. Because direct evidence in this population remains limited, we distinguish findings derived from HIV-associated cervical cancer from supporting evidence obtained in other HIV-associated malignancies, HIV-negative cervical cancer, and broader studies of HIV, HPV, and mucosal immunology. We propose a provisional inflamed, exhausted, and mucosally disrupted (IEM) framework to organize these interacting immune processes and generate hypotheses for prospective validation. This framework highlights why conventional biomarkers, including PD-L1 expression and peripheral CD4 T-cell counts, may incompletely capture immunotherapy-relevant immune heterogeneity and supports the evaluation of multidimensional biomarkers. We further discuss how the proposed framework could inform mechanism-matched therapeutic hypotheses and a novel two-dimensional clinical trial stratification model, while explicitly emphasizing that IEM is not yet a validated clinical phenotype or routine treatment-selection tool. Prospective studies incorporating women living with HIV are required to determine whether these immune features predict immunotherapy efficacy or toxicity and to establish more inclusive, biologically informed clinical-trial strategies.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1953030","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:52:36Z","timestamp":1789386756000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV-associated immune remodeling in cervical cancer: implications for immunotherapy, biomarkers, and trial design"],"prefix":"10.3389","volume":"17","author":[{"given":"Li","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Oncology, Guiyang Public Health Clinical Center","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Guiyang Public Health Clinical Center","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhou","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guiyang Public Health Clinical Center","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pathology, Guiyang Public Health Clinical Center","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manna","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Guiyang Public Health Clinical Center","place":["Guiyang, Guizhou, 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