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Infectious Agents and Cancer

Open Access

Cervical cancer epidemiology among HIV-infected women in North America

  • Gypsyamber D'Souza1Email author,
  • Yuezhou Jing1,
  • Howard Strickler10,
  • Michael Silverberg2,
  • Eric Engels3,
  • Ronald Bosch4,
  • John T Brooks5,
  • Robert Dubrow6,
  • Joseph Eron7,
  • Kelly Gebo8,
  • M J Gill9,
  • Bob Hogg11,
  • Mari Kitahata12,
  • Marina Klein13,
  • Richard Moore8,
  • Sean Rourke14 and
  • Alison G Abraham1
Infectious Agents and Cancer20105(Suppl 1):A9

Published: 11 October 2010


Cervical CancerInvasive Cervical CancerCalendar PeriodCervical Cancer RiskCervical Cancer Incidence


Initial studies suggest immunosuppression may be associated with the increased rates of precancerous cervical lesions observed in HIV-infected compared with HIV-uninfected individuals, but few studies have large enough populations to study the effect on invasive cancer. To characterize the incidence of cervical cancer among HIV-infected women in the HAART era, we examined data from the NA-ACCORD HIV cohort collaboration of IeDEA.

Materials and methods

This analysis includes data from 13 North American cohorts of HIV-infected women that collected clinically confirmed or cancer registry-linked data on invasive cervical cancer. Cervical cancer-free women were followed from the first HAART era CD4+ measurement (1996 onwards) until the earliest of: cervical cancer diagnosis, lost to followup, death, or December 2007. Incidence rate overall, by calendar period, and by first CD4+ cell count after 1995 (baseline) were standardized for age using the 2000 U.S. standard population.


Among the 16,467 HIV-infected women free of disease at baseline, 102 cases of invasive cervical cancer were reported, yielding an age-standardized incidence rate of 114 per 100,000 person-years (95% CI: 88–139). Of those cases, 40 (39%) were HAART-naïve at the time of diagnosis. Among women ≤39, 40-49, and ≥50 years of age the incidence rates were 122, 142, and 89 per 100,000 person-years, respectively. The age-standardized incidence rates by calendar periods for 1996-1999, 2000-2003, and 2004-2007 were 133, 152, and 87 per 100,000 person-years, respectively, showing no trend. The age-standardized incidence rates by baseline CD4+ categories of >350, 200-350 and <200 cells/μL were 68, 113, and 185, respectively, indicating an increasing rate with declining CD4+ cell count (Ptrend<0.001). Among 13,716 HIV-negative women free of disease in these cohorts, there were 10 invasive cervical cancers for an incidence of 12.3 per 100,000 person-years (95% CI 6.6-23), similar to the age-adjusted SEER population incidence of 8.2 per 100,000 person-years.


In this large collaboration of North American HIV cohorts, the estimate of cervical cancer incidence was almost 10-fold higher among HIV-infected than uninfected women in these cohorts. Although an effect of increased sexual risk-taking in HIV-infected women and/or differences in screening cannot be excluded, the strong association with lower baseline CD4+ cell count suggests a single low CD4 measurement may predict increased cervical cancer risk. It is unclear whether improvements in HIV-therapies during the HAART era have influenced cervical cancer rates; although no significant trend in incidence was observed over time, a decrease was observed in 2004-07.



This work is presented on behalf of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA.

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at

Authors’ Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Kaiser Permanente Northern California, Oakland, USA
Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, USA
Department of Biostatistics, Harvard University, Boston, USA
Centers for Disease Control and Prevention, Atlanta, USA
Division of Chronic Disease Epidemiology Yale University, New Haven, USA
Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, USA
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
Department of Medicine, University of Calgary, Calgary, Canada
Department of Epidemiology, University of California at San Francisco, San Francisco, USA
BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
Department of Medicine, University of Washington, Seattle, USA
McGill University, Montreal, Canada
Department of Psychiatry, University of Toronto, Toronto, Canada


© D'Souza et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.