Simon P. Boni

Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study

AbstractObjectiveTo assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART).MethodsA cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow‐up data were collected through facility‐ and phone‐based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively.ResultsOverall, 294 women with ICC aged 50 years (interquartile range [IQR] 43–60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III–IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV‐uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV‐uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I–II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01–6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96–6.96). The 2‐year OS was 37.9% (95% CI 30.0–47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60–1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02–2.47).ConclusionIn a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities.

High‐risk human papillomavirus distribution according to human immunodeficiency virus status among women with cervical cancer in Abidjan, Côte d'Ivoire, 2018 to 2020

AbstractAs human papillomavirus (HPV) immunisation and HPV‐based cervical cancer (CC) screening programmes expand across sub‐Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high‐risk (HR)‐HPV distribution among women with CC in Côte d'Ivoire. From July 2018 to June 2020, paraffin‐embedded CC specimens diagnosed in Abidjan, Côte d'Ivoire were systematically collected and tested for HR‐HPV DNA. Type‐specific HR‐HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0‐60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373‐833] cells/mm3 and 86% were on antiretroviral therapy (ART). The overall HR‐HPV prevalence was 89.4% [95% CI: 84.7‐94.1]. All were single HR‐HPV infections with no differences according to HIV status (P = .8). Among HR‐HPV‐positive CC specimens, the most prevalent HR‐HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9‐86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3‐86.5] in women without HIV (P = .3). The study confirms the major role of HPV16/18 in CC in Côte d'Ivoire and should support a regional scale‐up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR‐HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Côte d'Ivoire, both for WLHIV and women without HIV.