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Multicenter Study
. 2013 Apr 1;62(4):405-13.
doi: 10.1097/QAI.0b013e31828177d7.

Invasive cervical cancer risk among HIV-infected women: a North American multicohort collaboration prospective study

Alison G Abraham  1 , Gypsyamber D'Souza, Yuezhou Jing, Stephen J Gange, Timothy R Sterling, Michael J Silverberg, Michael S Saag, Sean B Rourke, Anita Rachlis, Sonia Napravnik, Richard D Moore, Marina B Klein, Mari M Kitahata, Gregory D Kirk, Robert S Hogg, Nancy A Hessol, James J Goedert, M John Gill, Kelly A Gebo, Joseph J Eron, Eric A Engels, Robert Dubrow, Heidi M Crane, John T Brooks, Ronald J Bosch, Howard D Strickler; North American AIDS Cohort Collaboration on Research and Design of IeDEA
Collaborators, Affiliations
Multicenter Study

Invasive cervical cancer risk among HIV-infected women: a North American multicohort collaboration prospective study

Alison G Abraham et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic human papillomavirus infection-the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women.

Methods: Data were obtained from HIV-infected and -uninfected female participants in the North American AIDS Cohort Collaboration on Research and Design with no history of ICC at enrollment. Participants were followed from study entry or January 1996 through ICC, loss to follow-up, or December 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios. All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction.

Results: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 person-years, respectively). HIV-infected women with baseline CD4+ T-cells of ≥350, 200-349, and <200 cells per microliter had a 2.3, 3.0, and 7.7 times increase in ICC incidence, respectively, compared with HIV-uninfected women (P(trend) = 0.001). Of the 17 HIV-infected women, medical records for the 5 years before diagnosis showed that 6 had no documented screening, 5 had screening with low-grade or normal results, and 6 had high-grade results.

Conclusions: This study found elevated incidence of ICC in HIV-infected compared with -uninfected women, and these rates increased with immunosuppression.

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Conflict of interest statement

Conflicts of Interest: Dr. Tim Sterling’s institution, Vanderbilt, has received research grants on his behalf from Pfizer and BMS to conduct observational HIV studies.

Figures

Figure 1
Figure 1
Non-parametric estimation of the cumulative incidence of cervical cancer among all validated cases (prevalent and incident). 1A) Cumulative incidence of cervical cancer (ICC) per 100,000 person-years, by time-updated age, in HIV-infected compared with HIV-uninfected women in NA-ACCORD and compared with the general U.S. population sampled by SEER. 1B) Cumulative ICC per 100,000 person-years by time-updated age, by baseline HIV status and CD4 cell count. 1C) Cumulative incidence of ICC per 100,000 person-years by time-updated age, by baseline HIV status and HIV viral load.
Figure 2
Figure 2
CD4 T-cell count mean trajectories and 95% CIs over time among incident invasive cervical cancer cases (dashed) and matched controls (solid) from NA-ACCORD cohorts. 2A) trajectories of cases and controls matched at antiretroviral therapy (ART) initiation on CD4 T-cell count, age, cohort, year of ART initiation, and time subject followed after ART initiation. 2B) trajectories of cases and controls matched at ICC diagnosis on ART use, age and calendar year.
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