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Int J Cancer. 2019 Jun 19. doi: 10.1002/ijc.32260. [Epub ahead of print]

Cervical cancer risk in women living with HIV across four continents: A multicohort study.

Author information

1
Institute of Social and Preventive Medicine, University of Bern, Switzerland.
2
CTU Bern, University of Bern, Switzerland.
3
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
4
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
5
Department of Medicine, McCord Hospital, Durban, South Africa.
6
Johns Hopkins University, School of Medicine, Baltimore, Maryland.
7
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
8
University of Calgary, Alberta, Canada.
9
Division of Research, Kaiser Permanente Northern California, Oakland, USA.
10
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
11
Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia.
12
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, USA.
13
TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
14
Reims Champagne-Ardenne University, Faculté de médecine, CHU Reims, Hôpital Robert Debré, Tropical and Infectious Diseases, Reims, France.
15
IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectious Diseases and Rheumathology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.
16
AIDS Unit, Clinic of Venereologic and Dermatologic Diseases, Athens Medical School, "Syngros" Hospital, Athens, Greece.
17
CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France.
18
Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France.
19
Department Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.
20
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
21
German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany.
22
King's College Hospital NHS Foundation Trust, London, UK.
23
Institute for Global Health, UCL, London, United Kingdom.
24
Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain.
25
Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
26
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
27
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
28
Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Cochin Hôtel-Dieu, Paris, France.
29
Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy.
30
Infectious and Tropical Diseases Institute, University of Brescia, Brescia, Italy.
31
Infectious Diseases Clinics, University Hospital, Modena, Italy.
32
Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
33
INSERM, U1018, Epidemiology of HIV, Reproduction, Paediatrics, CESP, University Paris-Sud, Paris, France.
34
Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France.
35
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
36
Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
37
Hospital General Universitario, Castellón, Spain.
38
International Agency for Research on Cancer, Lyon, France.
39
Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
40
Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.

Abstract

We compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and 2014. We analyzed cohort data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord. We used flexible parametric survival models to determine regional ICC rates and risk factors for incident ICC. We included 64,231 women from 45 countries. During 320,141 person-years (pys), 356 incident ICC cases were diagnosed (Europe 164, South Africa 156, North America 19 and Latin America 17). Raw ICC incidence rates per 100,000 pys were 447 in South Africa (95% confidence interval [CI]: 382-523), 136 in Latin America (95% CI: 85-219), 76 in North America (95% CI: 48-119) and 66 in Europe (95% CI: 57-77). Compared to European women ICC rates at 5 years after ART initiation were more than double in Latin America (adjusted hazard ratio [aHR]: 2.43, 95% CI: 1.27-4.68) and 11 times higher in South Africa (aHR: 10.66, 95% CI: 6.73-16.88), but similar in North America (aHR: 0.79, 95% CI: 0.37-1.71). Overall, ICC rates increased with age (>50 years vs. 16-30 years, aHR: 1.57, 95% CI: 1.03-2.40) and lower CD4 cell counts at ART initiation (per 100 cell/μl decrease, aHR: 1.25, 95% CI: 1.15-1.36). Improving access to early ART initiation and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer-related health inequities.

KEYWORDS:

HIV; cervical cancer; cohort study; incidence rate

PMID:
31215037
DOI:
10.1002/ijc.32260

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