TY - JOUR
T1 - Cervical cancer risk in women living with HIV across four continents
T2 - A multicohort study
AU - Rohner, Eliane
AU - Bütikofer, Lukas
AU - Schmidlin, Kurt
AU - Sengayi, Mazvita
AU - Maskew, Mhairi
AU - Giddy, Janet
AU - Taghavi, Katayoun
AU - Moore, Richard D
AU - Goedert, James J
AU - Gill, M John
AU - Silverberg, Michael J
AU - D'Souza, Gypsyamber
AU - Patel, Pragna
AU - Castilho, Jessica L
AU - Ross, Jeremy
AU - Sohn, Annette
AU - Bani-Sadr, Firouze
AU - Taylor, Ninon
AU - Paparizos, Vassilios
AU - Bonnet, Fabrice
AU - Verbon, Annelies
AU - Vehreschild, Jörg Janne
AU - Post, Frank A
AU - Sabin, Caroline
AU - Mocroft, Amanda
AU - Dronda, Fernando
AU - Obel, Niels
AU - Grabar, Sophie
AU - Spagnuolo, Vincenzo
AU - Quiros-Roldan, Eugenia
AU - Mussini, Cristina
AU - Miro, José M
AU - Meyer, Laurence
AU - Hasse, Barbara
AU - Konopnicki, Deborah
AU - Roca, Bernardino
AU - Barger, Diana
AU - Clifford, Gary M
AU - Franceschi, Silvia
AU - Egger, Matthias
AU - Bohlius, Julia
N1 - © 2019 UICC.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - Adolescent
KW - Adult
KW - Age Factors
KW - Anti-Retroviral Agents/therapeutic use
KW - CD4 Lymphocyte Count
KW - Cross-Cultural Comparison
KW - Early Detection of Cancer
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - HIV Infections/blood
KW - Health Status Disparities
KW - Humans
KW - Incidence
KW - Latin America/epidemiology
KW - Middle Aged
KW - North America/epidemiology
KW - Risk Factors
KW - South Africa/epidemiology
KW - Uterine Cervical Neoplasms/complications
KW - Young Adult
U2 - 10.1002/ijc.32260
DO - 10.1002/ijc.32260
M3 - Journal article
C2 - 31215037
SN - 0020-7136
VL - 146
SP - 601
EP - 609
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 3
ER -