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

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  • Eliane Rohner
  • Lukas Bütikofer
  • Kurt Schmidlin
  • Mazvita Sengayi
  • Mhairi Maskew
  • Janet Giddy
  • Katayoun Taghavi
  • Richard D Moore
  • James J Goedert
  • M John Gill
  • Michael J Silverberg
  • Gypsyamber D'Souza
  • Pragna Patel
  • Jessica L Castilho
  • Jeremy Ross
  • Annette Sohn
  • Firouze Bani-Sadr
  • Ninon Taylor
  • Vassilios Paparizos
  • Fabrice Bonnet
  • Annelies Verbon
  • Jörg Janne Vehreschild
  • Frank A Post
  • Caroline Sabin
  • Amanda Mocroft
  • Fernando Dronda
  • Niels Obel
  • Sophie Grabar
  • Vincenzo Spagnuolo
  • Eugenia Quiros-Roldan
  • Cristina Mussini
  • José M Miro
  • Laurence Meyer
  • Barbara Hasse
  • Deborah Konopnicki
  • Bernardino Roca
  • Diana Barger
  • Gary M Clifford
  • Silvia Franceschi
  • Matthias Egger
  • Julia Bohlius
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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.

Original languageEnglish
JournalInternational Journal of Cancer
Volume146
Issue number3
Pages (from-to)601-609
Number of pages9
ISSN0020-7136
DOIs
Publication statusPublished - 1 Feb 2020

    Research areas

  • Adolescent, Adult, Age Factors, Anti-Retroviral Agents/therapeutic use, CD4 Lymphocyte Count, Cross-Cultural Comparison, Early Detection of Cancer, Europe/epidemiology, Female, Follow-Up Studies, HIV Infections/blood, Health Status Disparities, Humans, Incidence, Latin America/epidemiology, Middle Aged, North America/epidemiology, Risk Factors, South Africa/epidemiology, Uterine Cervical Neoplasms/complications, Young Adult

ID: 59436291