Cervical cancer risk in women living with HIV across four continents: A multicohort study
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.
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Funding
Core A: AdministrativeAdministrative Core (Core A)Multicenter AIDS Cohort Study - Part B (Baltimore Center)Studies of Ocular Complications of AIDS - Chairman's OfficeDevelopmental CoreAdministrative Core (Core A)Atlanta Clinical and Translational Science Institute (ACTSI) RenewalUW Clinical HIV Integrated Research ProgramMULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCHMiami Womens Interagency HIV Study WIHSSouthern California Women's Interagency HIV Study ConsortiumWIHS Data Management and Analysis Center (WDMAC)Disparities in the HIV Care Continuum among Hispanics in the United StatesClinical and Translational Science InstituteAlcohol and HIV Treatment and Clinical ProgressionVIRAL INFECTIONS AMONG PERSONS WITH HEMOPHILIAMedical Research Council Grant MR/M004236/1Visual outcomes & quality of life in CMV retinitisStatistical and Data Management Center for the AIDS Clinical Trials GroupSouthern California Women's Interagency HIV Study ConsortiumHIV Disease Outcomes in Drug Users in Clinical PracticeVisual outcomes & quality of life in CMV retinitisUAB-MISS WIHS CohortUW Clinical HIV Integrated Research ProgramAntiretroviral Therapy Strategies to Lower Cancer Risk in HIV-Infected PersonsChicago WIHS Consortium V (CWC)Administrative Supplement - Financial Incentives, Randomization with Stepped Treatment (FIRST) TrialEpidemiology and Natural History of Cancer-Associated VirusesCenter/Coordination, Analysis and Management/MACSEpidemiology and Natural History of Cancer-Associated VirusesBrooklyn Women's Interagency HIV Study (WIHS) VUNC Clinical and Translational Science AwardChallenging and Expanding Paradigms of Aging with HIVUniversity of North Carolina Womens Interagency HIV Study UNC WIHSClinical CoreWomen's Interagency HIV Study (WIHS-V)Clinical and Translational Science InstituteOPTICAL IMAGING FACILITYHIV and Substance AbuseWIHS Data Management and Analysis Center (WDMAC)The Connie Wofsy Women's HIV StudyAntiretroviral Therapy Strategies to Lower Cancer Risk in HIV-Infected PersonsHIV and Substance AbuseCORRELATES OF DRUG USE AND HEART DISEASEThe dynamics of HIV, aging, and T lymphocyte exhaustionJohns Hopkins HIV Clinical Cohort1/6 COMpAAAS U24: Coordinating CenterOPTICAL IMAGING FACILITYSTATISTICAL AND DATA MANAGEMENT CENTERINCIDENCE OF HIV INFECTION IN A COHORT OF IV DRUG USERSCOLLABORATIONS & PARTNERSHIPSCaribbean, Central, and South America network for HIV Epidemiology (CCASAnet)STATISTICAL AND DATA MANAGEMENT CENTERThe Connie Wofsy Women's HIV StudyClinical and Translational Science InstituteHousing Scientific Working GroupHIV Disease Outcomes in Drug Users in Clinical PracticeMULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCH LABSUCSD Department of Medicine HIV/AIDS Clinical Trials UnitThe HIV Care Continuum and Health Policy: Changes through Context and GeographyThe dynamics of HIV, aging, and T lymphocyte exhaustionStatistical and Data Management Center (SDMC), Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG)North American AIDS Cohorts on Collaboration and Design (NAACCORD)University of Pittsburgh Multicenter AIDS Cohort Study (MACS)CFAR Network of Integrated Clinical Systems (CNICS)NIH HHS Grant N01CP01004Brooklyn Women's Interagency HIV Study (WIHS) VCenter/Coordination, Analysis and Management/MACSUCSD Department of Medicine HIV/AIDS Clinical Trials UnitAlcohol Associated Outcomes Among HIV+/-Aging VeteransNIH HHS Grant N02CP055504ADULT ACTG CENTRAL GROUPNatural History of AIDS in Homosexual MenHRSA HHS Grant 90051652Institute of Translational Health SciencesStudies of Ocular Complications of AIDS - Coordinating CenterAIDS Clinical Trials Group NetworkWashington Women's Interagency HIV/AIDS StudyStudies of Ocular Complications of AIDS - Reading CenterCORRELATES OF DRUG USE AND HEART DISEASENIH HHS Grant P30MH62246Atlanta Clinical and Translational Science Institute (ACTSI) RenewalStudies of Ocular Complications of AIDS - Chairman's OfficeADULT ACTG CENTRAL GROUPMiami Womens Interagency HIV Study WIHSWashington Women's Interagency HIV/AIDS StudyUniversity of Pittsburgh Multicenter AIDS Cohort Study (MACS)Studies of Ocular Complications of AIDS - Coordinating CenterAdministrative Supplement - Financial Incentives, Randomization with Stepped Treatment (FIRST) TrialAdministrative Core (Core A)Housing Scientific Working GroupChallenging and Expanding Paradigms of Aging with HIVNorth American AIDS Cohorts on Collaboration and Design (NAACCORD)Patient-Oriented Research and Mentorship in HIV and Non-Communicable DiseasesMentoring in HIV and Tuberculosis ResearchIeDEA Asia-Pacific Research CollaborationUAB-MISS WIHS CohortAlcohol Associated Outcomes Among HIV+/-Aging VeteransAdministrative Core (Core A)NCI NIH HHS Grant N02 CP055504CDC HHS Grant CDC-200-2015-63931CFAR Network of Integrated Clinical Systems (CNICS)MULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCH LABSCore G: Clinical and Comorbidity ResearchCore G: Clinical and Comorbidity ResearchUNC Clinical and Translational Science AwardINCIDENCE OF HIV INFECTION IN A COHORT OF IV DRUG USERSUNC Center for AIDS Research Core A AdministrationCDC HHS Grant CDC-200-2006-18797Emory WIHS CRS - Longitudinal CohortCOLLABORATIONS & PARTNERSHIPSNatural History of AIDS in Homosexual MenWomen's Interagency HIV Study (WIHS-V)Institute of Translational Health SciencesIntramural CDC HHS Grant CC999999Clinical CoreMULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCHMulticenter AIDS Cohort Study - Part B (Baltimore Center)Alcohol and HIV Treatment and Clinical ProgressionChicago WIHS Consortium V (CWC)Patient-Oriented Research and Mentorship in HIV and Non-Communicable DiseasesMentoring in HIV and Tuberculosis ResearchClinical and Translational Science InstituteUniversity of North Carolina Womens Interagency HIV Study UNC WIHSNIH HHS Grant Z01CP010214Emory WIHS CRS - Longitudinal CohortMultimorbidity among HIV-Infected Adults in North America from 2000-2010World Health Organization Grant 001Multimorbidity among HIV-Infected Adults in North America from 2000-2010Multicenter AIDS Cohort StudyThe Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the USJohns Hopkins HIV Clinical CohortThe Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the USStudies of Ocular Complications of AIDS - Reading CenterCore A: AdministrativeNIH HHS Grant N02CP91027International epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa.1/6 COMpAAAS U24: Coordinating CenterAIDS Linked to the IntraVenous Experience (ALIVE) StudyAIDS Clinical Trials Group NetworkStatistical and Data Management Center for the AIDS Clinical Trials GroupUNC Center for AIDS Research Core A AdministrationMulticenter AIDS Cohort StudyAgency for Healthcare Research and Quality Grant 90047713Augustinus Fonden FundingCanadian Institutes of Health Research Grant CBR‐86906Canadian Institutes of Health Research Grant CBR‐94036Canadian Institutes of Health Research Grant HCP‐97105Canadian Institutes of Health Research Grant TGF‐96118Centers for Disease Control and Prevention Grant CDC‐200‐2006‐18797Centers for Disease Control and Prevention Grant CDC‐200‐2015‐63931Health Resources and Services Administration Grant 90051652National Institute of Mental Health FundingNational Institute of Allergy and Infectious Diseases Grant U01‐AI069918National Institute of Allergy and Infectious Diseases Grant U01A1096186IeDEA Asia-Pacific Research CollaborationCaribbean, Central, and South America network for HIV Epidemiology (CCASAnet)International epidemiology Databases to Evaluate AIDS (IeDEA) Southern Africa.National Institute on Drug Abuse FundingNorth American AIDS Cohorts on Collaboration and Design (NAACCORD)Disparities in the HIV Care Continuum among Hispanics in the United StatesThe HIV Care Continuum and Health Policy: Changes through Context and GeographyMultimorbidity among HIV-Infected Adults in North America from 2000-2010OPTICAL IMAGING FACILITYChallenging and Expanding Paradigms of Aging with HIVThe dynamics of HIV, aging, and T lymphocyte exhaustionVisual outcomes & quality of life in CMV retinitisMentoring in HIV and Tuberculosis ResearchPatient-Oriented Research and Mentorship in HIV and Non-Communicable DiseasesHIV and Substance AbuseInstitute of Translational Health SciencesCORRELATES OF DRUG USE AND HEART DISEASENational Institutes of Health Grant N01CP01004National Institutes of Health Grant N02CP055504National Institutes of Health Grant N02CP91027Core G: Clinical and Comorbidity ResearchHousing Scientific Working GroupAdministrative Core (Core A)Core A: AdministrativeUNC Center for AIDS Research Core A AdministrationClinical CoreAdministrative Core (Core A)National Institutes of Health Grant P30MH62246Alcohol and HIV Treatment and Clinical ProgressionThe Silver Tsunami: Projecting multimorbidity, polypharmacy,and healthcare costs for those aging with HIV in the USCFAR Network of Integrated Clinical Systems (CNICS)Alcohol Associated Outcomes Among HIV+/-Aging VeteransAntiretroviral Therapy Strategies to Lower Cancer Risk in HIV-Infected PersonsHIV Disease Outcomes in Drug Users in Clinical PracticeINCIDENCE OF HIV INFECTION IN A COHORT OF IV DRUG USERSAdministrative Supplement - Financial Incentives, Randomization with Stepped Treatment (FIRST) TrialBrooklyn Women's Interagency HIV Study (WIHS) VThe Connie Wofsy Women's HIV StudyChicago WIHS Consortium V (CWC)Washington Women's Interagency HIV/AIDS StudyWomen's Interagency HIV Study (WIHS-V)Multicenter AIDS Cohort StudyNatural History of AIDS in Homosexual MenUniversity of Pittsburgh Multicenter AIDS Cohort Study (MACS)Multicenter AIDS Cohort Study - Part B (Baltimore Center)MULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCH LABSMULTICENTER AIDS COHORT STUDY PATHOGENESIS RESEARCHSTATISTICAL AND DATA MANAGEMENT CENTERADULT ACTG CENTRAL GROUPWIHS Data Management and Analysis Center (WDMAC)Statistical and Data Management Center for the AIDS Clinical Trials GroupAIDS Clinical Trials Group NetworkUCSD Department of Medicine HIV/AIDS Clinical Trials UnitUW Clinical HIV Integrated Research ProgramUniversity of North Carolina Womens Interagency HIV Study UNC WIHSMiami Womens Interagency HIV Study WIHSUAB-MISS WIHS CohortEmory WIHS CRS - Longitudinal CohortAIDS Linked to the IntraVenous Experience (ALIVE) StudyJohns Hopkins HIV Clinical CohortSouthern California Women's Interagency HIV Study ConsortiumStudies of Ocular Complications of AIDS - Coordinating CenterStudies of Ocular Complications of AIDS - Chairman's OfficeStudies of Ocular Complications of AIDS - Reading Center1/6 COMpAAAS U24: Coordinating CenterCOLLABORATIONS & PARTNERSHIPSClinical and Translational Science InstituteClinical and Translational Science InstituteUNC Clinical and Translational Science AwardAtlanta Clinical and Translational Science Institute (ACTSI) RenewalCenter/Coordination, Analysis and Management/MACSEpidemiology and Natural History of Cancer-Associated VirusesNational Institutes of Health Grant Z01CP010214Seventh Framework Programme Grant 260694United States Agency for International Development Grant INROADS USAID‐674‐A‐12‐00029National Cancer Institute FundingEunice Kennedy Shriver National Institute of Child Health and Human Development Funding