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. 2024 Jan 15;154(2):273-283.
doi: 10.1002/ijc.34707. Epub 2023 Sep 2.

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Nathalie Verónica Fernández Villalobos  1 , Yann Ruffieux  1 , Andreas D Haas  1 , Chido Chinogurei  2 , Morna Cornell  2 , Katayoun Taghavi  1 , Matthias Egger  1   2   3 , Naomi Folb  4 , Gary Maartens  5 , Eliane Rohner  1
Affiliations

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Nathalie Verónica Fernández Villalobos et al. Int J Cancer. .

Abstract

HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub-Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston-Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3-fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval [CI]: 2.40-3.73). For all endpoints of interest, the estimated incidence rates were higher in WLWH than women without HIV. Cervical cancer rates among WLWH increased at early ages and peaked at 49 years (122/100 000 person-years; 95% CI: 100-147), whereas, in women without HIV, incidence rates peaked at 56 years (40/100 000 person-years; 95% CI: 36-45). Cervical precancer rates peaked in women in their 30s. Analyses of age-specific cervical cancer rates by HIV status are essential to inform the design of targeted cervical cancer prevention policies in Southern Africa and other regions with a double burden of HIV and cervical cancer.

Keywords: HIV; South Africa; uterine cervical dysplasia; uterine cervical neoplasms.

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Conflict of interest statement

Conflict of Interest

The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. N. Folb is employed by Medscheme, the company that facilitated the provision of the data for our study.

Figures

Figure 1:
Figure 1:
Incidence rate per 100 000 person-years as a function of age, by endpoint of interest. The shaded areas represent 95% confidence intervals.
Figure 2:
Figure 2:
Incidence rate per 100 000 person-years as a function of age and HIV status, by endpoint of interest. The shaded areas represent 95% confidence intervals.
Figure 3:
Figure 3:
Hazard ratio by endpoint of interest comparing women with HIV to women without HIV, as a function of age. The shaded areas represent 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209–49. - PubMed
    1. Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE. Human Papillomavirus Testing in the Prevention of Cervical Cancer. JNCI: Journal of the National Cancer Institute 2011;103:368–83. - PMC - PubMed
    1. Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res 2008;28:1763–6. - PubMed
    1. Nobbenhuis MA, Helmerhorst TJ, van den Brule AJ, Rozendaal L, Voorhorst FJ, Bezemer PD, Verheijen RH, Meijer CJ. Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. The Lancet 2001;358:1782–3. - PubMed
    1. Moscicki A-B, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, Miller S, Canjura-Clayton LK, Farhat S, Broering JM, Darragh TM. Regression of low-grade squamous intra-epithelial lesions in young women. The Lancet 2004;364:1678–83. - PubMed

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