Invasive cervical cancer rates high in women living with HIV in Africa and Latin America

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uterusA study has found that rates of invasive cervical cancer (ICC) are particularly high in women living with HIV in South Africa or Latin America.

For the study, researchers compared ICC rates in 45 countries across Europe, South Africa, Latin, and North America among women living with HIV who initiated antiretroviral therapy between 1996 and 2014, through a collaboration between global HIV cohort research networks. Among 64,231 women in the analysis, 356 incident ICC cases were diagnosed (164 in Europe, 156 in South Africa, 19 in North America, and 17 in Latin America). Compared with rates in European women, ICC rates at 5 years after initiating antiretroviral therapy were more than double in Latin America and 11-times higher in South Africa, but similar in North America.

The investigators noted that improving access to early antiretroviral treatment and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer-related health inequities.

“Cervical cancer is a preventable disease, but many women living with HIV, especially in Latin America and South Africa, are still being diagnosed with this potentially deadly cancer,” said corresponding author Dr Eliane Rohner, of the University of Bern, in Switzerland, representing the International Epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa collaboration. “We need to improve access to effective cervical cancer screening and treatment for women living with HIV globally.”

Abstract
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.

Authors
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

Wiley material
International Journal of Cancer abstract


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