Cervical cancer risk in women living with HIV across four continents: A multicohort study: International Journal of Cancer

E. Rohner, L. Bütikofer, K. Schmidlin, M. Sengayi, M. Maskew, J. Giddy, K. Taghavi, R.D. Moore, J.J. Goedert, M.J. Gill, M.J. Silverberg, G. D'Souza, P. Patel, J.L. Castilho, J. Ross, A. Sohn, F. Bani-Sadr, N. Taylor, V. Paparizos, F. BonnetA. Verbon, J.J. Vehreschild, F.A. Post, C. Sabin, A. Mocroft, F. Dronda, N. Obel, S. Grabar, V. Spagnuolo, E. Quiros-Roldan, C. Mussini, J.M. Miro, L. Meyer, B. Hasse, D. Konopnicki, B. Roca, D. Barger, G.M. Clifford, S. Franceschi, M. Egger, J. Bohlius

Research output: Contribution to journalArticlepeer-review


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. © 2019 UICC
Original languageEnglish
Pages (from-to)601-609
Number of pages9
JournalInt. J. Cancer
Issue number3
Publication statusPublished - 2020


  • cervical cancer
  • cohort study
  • HIV
  • incidence rate
  • antiretrovirus agent
  • adolescent
  • adult
  • age distribution
  • antiretroviral therapy
  • Article
  • cancer risk
  • cancer screening
  • cancer survival
  • CD4 lymphocyte count
  • cohort analysis
  • confidence interval
  • controlled study
  • data analysis
  • data base
  • Europe
  • female
  • geographic distribution
  • hazard ratio
  • health care access
  • health care organization
  • human
  • Human immunodeficiency virus infected patient
  • Human immunodeficiency virus infection
  • incidence
  • major clinical study
  • medical research
  • North America
  • priority journal
  • risk factor
  • South Africa
  • South and Central America
  • time to treatment
  • uterine cervix cancer
  • women's health
  • age
  • blood
  • clinical trial
  • complication
  • cultural factor
  • early cancer diagnosis
  • follow up
  • health disparity
  • middle aged
  • multicenter study
  • uterine cervix tumor
  • young adult
  • Adolescent
  • Adult
  • Age Factors
  • Anti-Retroviral Agents
  • CD4 Lymphocyte Count
  • Cross-Cultural Comparison
  • Early Detection of Cancer
  • Female
  • Follow-Up Studies
  • Health Status Disparities
  • HIV Infections
  • Humans
  • Incidence
  • Latin America
  • Middle Aged
  • Risk Factors
  • Uterine Cervical Neoplasms
  • Young Adult


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