Incidence and outcomes of anal and cervical cancer among adults with HIV in Latin America: a retrospective cohort study
Abstract
Introduction
Human papillomavirus (HPV)‐associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies in PWH in Latin America.
Methods
We included PWH from the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) who contributed person‐time between 2000 and 2019. We calculated crude and age‐standardized incidence rates, examining trends over time with Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models with propensity score adjustment. We calculated the probability of survival after cancer diagnosis using Kaplan−Meier curves. To understand factors that influence our results, we surveyed all adult CCASAnet sites on current practices of cervical and anal cancer screening.
Results
Overall, 5739 females with HIV (43,417 person‐years) were included in cervical cancer analyses. There were 27 incident cervical cancers: crude incidence rate of 62.2 (95% confidence interval [CI]: 34.9−89.4) per 100,000 person years. In the anal cancer analysis, 12,489 males who have sex with men (MSM), 7324 males other than MSM and 5739 females were included for a total of 25,552 PWH, contributing 157,166 person‐years. Anal cancer was diagnosed in 56 individuals: crude incidence rates of 59.1 [95% CI: 33.2−85.0], 20.7 [95% CI: 11.6−29.7] and 15.2 [95% CI: 8.6−21.9] per 100,000 person‐years in MSM, females and males other than MSM, respectively. Age‐standardized incidence rates did not significantly change over time. Anal cancer risk decreased significantly with higher time‐updated CD4 cell count. The predicted probability of 5‐year survival after cancer diagnosis was 72.6% (95% CI: 48.4−86.8) for cervical cancer and 58.5% (95% CI: 44.0−70.5) for anal cancer.
Conclusions
In one of the few reports outside the United States or Europe, we did not observe a decrease in age‐standardized incidence rates for anal and cervical cancer between 2000 and 2019. These data support continued efforts for cancer prevention through access to gender‐neutral HPV vaccination and cancer screening.