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 (Ptrend = 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.
*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
†Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
‡Division of Infectious Diseases, School of Medicine, Vanderbilt University, Nashville, TN
§Division of Research, Kaiser Permanente Northern California, Oakland, CA
||Division of Infectious Diseases, University of Alabama, Birmingham, AL
¶Ontario Treatment Network, University of Toronto, Toronto, ON, Canada
#Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
**Department of Medicine, Johns Hopkins University, Baltimore, MD
††Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
‡‡Department of Medicine, University of Washington, Seattle, WA
§§Department of Health Sciences, British Columbia Centre for Excellence and HIV/AIDS, Simon Fraser University, Vancouver, British Columbia, Canada
||||Department of Clinical Pharmacy & Medicine, University of California, San Francisco, CA
¶¶Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
##Department of Medicine, University of Calgary, Calgary, Alberta, Canada
***Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, CT
†††Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA
‡‡‡Department of Biostatistics, Harvard School of Public Health, Boston, MA
Correspondence to: Gypsyamber D’Souza, PhD or Alison G. Abraham, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe St, Suite E6132B, Baltimore, MD 21205 (e-mail: firstname.lastname@example.org; email@example.com).
Supported by the National Institutes of Health: U01-AI069918, U01-AA013566, U01-AI-35042, 5-M01-RR-00052 (General Clinical Research Centers), U01-AI- 35043, U01-AI-35039, U01-AI-35040, U01-AI-35041, U01-AI38855; AIDS Clinical Trials Group Longitudinal Linked Randomized Trials: U01-AI38858, U01-AI68634, U01-AI68636, AI-69432, AI-69434, U01-AI-35004, U01-AI-31834, U01-AI-34994, U01-AI-34989, U01-AI-34993, U01-AI-42590, U01-HD-32632, UL1-RR024131, P30-AI27757, K23-AI-61-0320, P30-AI27767, P30-AI50410, RR025747, P30-AI54999, R01-DA04334, R01-DA12568, R01-MH54907, R24-AI067039, N02-CP55504, Z01-CP010176, AHQ290-01-0012, K01-AI071754, K24-00432, R01-DA11602, K01-AI071725, R01 AG026250, and P30 AI027763; the Canadian Institutes for Health Research:TGF-96118, HCP-97105, CBR-86906, CBR-94036, and KRS-86251, 169621; and the Canadian Trials Network (project 242). R01DE021395 (G.D.) and K01AI071725 (M.S.) from the NIAID and by the Centers for Disease Control (CDC200-2006-18797) and R01-CA085178 (H.D.S.). Dr T. R. Sterling's institution, Vanderbilt, has received research grants on his behalf from Pfizer and BMS to conduct observational HIV studies. Dr M. Silverberg is a co-investigator on 2 pharma grants (Merck and Pfizer), both on HIV but unrelated to this topic. Dr G. D’Souza has research support from and was an advisor to Merck Inc.
Presented at the Oral Presentation for Eurogin Conference, July 8–11, 2012, Prague, Czech Republic.
Members of the North American AIDS Cohort Collaboration on Research and Design of IeDEA are listed in Appendix I.
Received August 31, 2012
Accepted December 04, 2012