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Low incidence of invasive cervical cancer among HIV-infected US women in a prevention program

Massad, L Stewart; Seaberg, Eric Ca; Watts, D Heatherb; Hessol, Nancy Ac; Melnick, Sandrad; Bitterman, Pincase; Anastos, Kathrynf; Silver, Sylviag; Levine, Alexandra Mh; Minkoff, Howardi

Epidemiology & Social: Concise Communication

Objective: To measure the incidence of invasive cervical cancer (ICC) in US women infected with HIV.

Design: Multicenter prospective cohort study, conducted between October 1994, and September 2001.

Setting: HIV research centers operating as six urban consortia in the Women's Interagency HIV Study.

Subjects: A total of 2131 women (462 HIV seronegative, 1661 HIV seropositive, and eight seroconverters). Women with a history of hysterectomy or of cervical cancer at baseline evaluation were excluded.

Intervention: Cervical cytology obtained at 6-month intervals, with a colposcopy referral threshold of atypia, followed by individualized treatment.

Main outcome measure: ICC diagnoses obtained from study databases and regional cancer registries and confirmed by a gynecologic pathologist.

Results: No incident ICC were observed in HIV seronegative women during 2375 woman-years of observation. During 8260 woman-years of observation, eight putative incident cases of cervical cancer were identified in HIV seropositive women, but only one was confirmed, yielding an incidence rate of 1.2/10 000 woman-years (95% confidence interval, 0.3–6.7/10 000 woman-years). The difference in incidence between HIV seropositive and seronegative women was not significant (P = 1.0).

Conclusion: ICC is uncommon in HIV-infected US women participating in a regular prevention program.

From the Southern Illinois University School of Medicine, Springfield, Ilinois, the aJohns Hopkins Bloomberg School of Public Health, Baltimore, the bNational Institute of Child Health and Human Development, Bethesda, Maryland, the cUniversity of California, San Francisco, California, the dNational Cancer Institute, Bethesda, Maryland, eRush Medical College, Chicago, Ilinois, fMontefiore Medical Center and Lincoln Medical and Mental Health Center, Bronx, New York, the gGeorge Washington University Medical Center, Washington, DC, hKeck School of Medicine, University of Southern California, Los Angeles, California, and the iMaimonides Medical Center, State University of New York, Brooklyn, New York, USA.

Correspondence to L. S. Massad, Department of Obstetrics & Gynecology, Southern Illinois University, P.O. Box 19640, Springfield, Illinois 62794-9640, USA.

Received: 28 February 2003; revised: 21 May 2003; accepted: 3 June 2003.

© 2004 Lippincott Williams & Wilkins, Inc.