TY - JOUR
T1 - Cervical cancer risk in women living with HIV across four continents
T2 - A multicohort study
AU - Rohner, Eliane
AU - Bütikofer, Lukas
AU - Schmidlin, Kurt
AU - Sengayi, Mazvita
AU - Maskew, Mhairi
AU - Giddy, Janet
AU - Taghavi, Katayoun
AU - Moore, Richard D.
AU - Goedert, James J.
AU - Gill, M. John
AU - Silverberg, Michael J.
AU - D'Souza, Gypsyamber
AU - Patel, Pragna
AU - Castilho, Jessica L.
AU - Ross, Jeremy
AU - Sohn, Annette
AU - Bani-Sadr, Firouze
AU - Taylor, Ninon
AU - Paparizos, Vassilios
AU - Bonnet, Fabrice
AU - Verbon, Annelies
AU - Vehreschild, Jörg Janne
AU - Post, Frank A.
AU - Sabin, Caroline
AU - Mocroft, Amanda
AU - Dronda, Fernando
AU - Obel, Niels
AU - Grabar, Sophie
AU - Spagnuolo, Vincenzo
AU - Quiros-Roldan, Eugenia
AU - Mussini, Cristina
AU - Miro, José M.
AU - Meyer, Laurence
AU - Hasse, Barbara
AU - Konopnicki, Deborah
AU - Roca, Bernardino
AU - Barger, Diana
AU - Clifford, Gary M.
AU - Franceschi, Silvia
AU - Egger, Matthias
AU - Bohlius, Julia
N1 - Funding Information:
Key words: cervical cancer, HIV, incidence rate, cohort study Abbreviations: aHR: adjusted hazard ratio; ART: antiretroviral therapy; CI: confidence interval; COHERE: Collaboration of Observational HIV Epidemiological Research in Europe; HIV: human immunodeficiency virus; HPV: human papillomavirus; ICC: invasive cervical cancer; IeDEA: International Epidemiology Databases to Evaluate AIDS; IQR: interquartile range; NNRTI: nonnucleoside reverse transcriptase inhibitor; PI: protease inhibitor; pys: person-years Additional Supporting Information may be found in the online version of this article. Conflicts of interest: FB received fees from ViiV Healthcare, Janssen, BMS, Gilead, and MSD for educational presentations and research grants from Gilead and Janssen. MJG has served as ad hoc member on Advisory HIV Boards to Merck, ViiV and Gilead in the past 3 years. AM has received honoraria, lecture fees, consultancy or travel support from Gilead and ViiV. MS has received research grants to his institution from Merck and Gilead. AS has received grants and travel support to her institution from ViiV Healthcare. JJV has personal fees from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), University Hospital Freiburg/Congress and Communication, Academy for Infectious Medicine, University Manchester, German Society for Infectious Diseases (DGI), Ärztekammer Nordrhein, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine (DGIM) and grants from Merck/MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), German Federal Ministry of Education and Research (BMBF). Grant sponsor: Agence Nationale de Recherches sur le Sida et les Hepatites Virales; Grant sponsor: Agency for Healthcare Research and Quality; Grant number: 90047713; Grant sponsor: Augustinus Fonden; Grant sponsor: Canadian Institutes of Health Research; Grant numbers: CBR-86906, CBR-94036, HCP-97105, TGF-96118; Grant sponsor: Centers for Disease Control and Prevention; Grant numbers: CDC-200-2006-18797, CDC-200-2015-63931; Grant sponsor: Government of Alberta, Canada; Grant sponsor: Health Resources and Services Administration; Grant number: 90051652; Grant sponsor: HIV Monitoring Foundation, The Netherlands; Grant sponsor: Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Grant sponsor: National Institute of Mental Health; Grant sponsor: National Institute of Allergy and Infectious Diseases; Grant numbers: U01-AI069918, U01A1096186, U01AI069907, U01AI069923, U01AI069924; Grant sponsor: National Institute on Drug Abuse; Grant sponsor: National Institutes of Health; Grant numbers: U01AI069918, F31AI124794, K01AI131895, F31DA037788, G12MD007583, K01AI093197, K23AI120875, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01 AG053100, R24AI067039, U01AA013566, R01CA165937, R01DA011602, R01DA012568, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010176, Z01CP010214; Grant sponsor: Ontario Ministry of Health and Long Term Care; Grant sponsor: Schweizerischer Nationalfonds zur Förderung derWissenschaftlichen Forschung; Grant numbers: PZ00P3_160407, 174281; Grant sponsor: Seventh Framework Programme; Grant number: 260694; Grant sponsor: United States Agency for International Development; Grant number: INROADS USAID-674-A-12-00029; Grant sponsor: National Cancer Institute; Grant sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development Ninon Taylor’s current address is: Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria DOI: 10.1002/ijc.32260 History: Received 15 Nov 2018; Accepted 1 Mar 2019; Online 19 Jun 2019. Correspondence to: Eliane Rohner, MD, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland, E-mail: eliane. rohner@ispm.unibe.ch
Funding Information:
Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver
Publisher Copyright:
© 2019 UICC
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - cervical cancer
KW - cohort study
KW - HIV
KW - incidence rate
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U2 - 10.1002/ijc.32260
DO - 10.1002/ijc.32260
M3 - Article
C2 - 31215037
AN - SCOPUS:85067883399
VL - 146
SP - 601
EP - 609
JO - International Journal of Cancer
JF - International Journal of Cancer
SN - 0020-7136
IS - 3
ER -