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Cervical cancer epidemiology among HIV-infected women in North America

Background

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.

Results

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.

Conclusions

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.

Acknowledgements

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 http://www.biomedcentral.com/1750-9378/5?issue=S1.

Author information

Correspondence to Gypsyamber D'Souza.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Cervical Cancer
  • Invasive Cervical Cancer
  • Calendar Period
  • Cervical Cancer Risk
  • Cervical Cancer Incidence