Invasive cervical cancer risk among HIV-infected women

A North American multicohort collaboration prospective study

Alison G. Abraham, Gypsyamber D'Souza, Yuezhou Jing, Stephen J. Gange, Timothy R. Sterling, Michael J. Silverberg, Michael S. Saag, Sean B. Rourke, Anita Rachlis, Sonia Napravnik, Richard D. Moore, Marina B. Klein, Mari M. Kitahata, Gregory D. Kirk, Robert S. Hogg, Nancy A. Hessol, James J. Goedert, M. John Gill, Kelly A. Gebo, Joseph J. Eron & 6 others Eric A. Engels, Robert Dubrow, Heidi M. Crane, John T. Brooks, Ronald J. Bosch, Howard Strickler

Research output: Contribution to journalReview article

90 Citations (Scopus)

Abstract

Objective: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic human papillomavirus infection-the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. Methods: Data were obtained from HIV-infected and -uninfected female participants in the North American AIDS Cohort Collaboration on Research and Design with no history of ICC at enrollment. Participants were followed from study entry or January 1996 through ICC, loss to follow-up, or December 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios. All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. Results: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 person-years, respectively). HIV-infected women with baseline CD4+ T-cells of $350, 200-349, and ,200 cells per microliter had a 2.3, 3.0, and 7.7 times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend = 0.001). Of the 17 HIV-infected women, medical records for the 5 years before diagnosis showed that 6 had no documented screening, 5 had screening with low-grade or normal results, and 6 had high-grade results. Conclusions: This study found elevated incidence of ICC in HIV infected compared with -uninfected women, and these rates increased with immune suppression.

Original languageEnglish (US)
Pages (from-to)405-413
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume62
Issue number4
DOIs
StatePublished - Apr 1 2013

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Uterine Cervical Neoplasms
HIV
Prospective Studies
Incidence
CD4 Lymphocyte Count
T-Lymphocytes
HIV Infections
Medical Records
Papillomavirus Infections
Cell Biology
Registries
Acquired Immunodeficiency Syndrome
Cohort Studies
Research Design
History
Observation
Pathology

Keywords

  • HIV-infection
  • Human papillomavirus
  • Immunosuppression
  • Invasive cervical cancer

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Invasive cervical cancer risk among HIV-infected women : A North American multicohort collaboration prospective study. / Abraham, Alison G.; D'Souza, Gypsyamber; Jing, Yuezhou; Gange, Stephen J.; Sterling, Timothy R.; Silverberg, Michael J.; Saag, Michael S.; Rourke, Sean B.; Rachlis, Anita; Napravnik, Sonia; Moore, Richard D.; Klein, Marina B.; Kitahata, Mari M.; Kirk, Gregory D.; Hogg, Robert S.; Hessol, Nancy A.; Goedert, James J.; Gill, M. John; Gebo, Kelly A.; Eron, Joseph J.; Engels, Eric A.; Dubrow, Robert; Crane, Heidi M.; Brooks, John T.; Bosch, Ronald J.; Strickler, Howard.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 62, No. 4, 01.04.2013, p. 405-413.

Research output: Contribution to journalReview article

Abraham, AG, D'Souza, G, Jing, Y, Gange, SJ, Sterling, TR, Silverberg, MJ, Saag, MS, Rourke, SB, Rachlis, A, Napravnik, S, Moore, RD, Klein, MB, Kitahata, MM, Kirk, GD, Hogg, RS, Hessol, NA, Goedert, JJ, Gill, MJ, Gebo, KA, Eron, JJ, Engels, EA, Dubrow, R, Crane, HM, Brooks, JT, Bosch, RJ & Strickler, H 2013, 'Invasive cervical cancer risk among HIV-infected women: A North American multicohort collaboration prospective study', Journal of Acquired Immune Deficiency Syndromes, vol. 62, no. 4, pp. 405-413. https://doi.org/10.1097/QAI.0b013e31828177d7
Abraham, Alison G. ; D'Souza, Gypsyamber ; Jing, Yuezhou ; Gange, Stephen J. ; Sterling, Timothy R. ; Silverberg, Michael J. ; Saag, Michael S. ; Rourke, Sean B. ; Rachlis, Anita ; Napravnik, Sonia ; Moore, Richard D. ; Klein, Marina B. ; Kitahata, Mari M. ; Kirk, Gregory D. ; Hogg, Robert S. ; Hessol, Nancy A. ; Goedert, James J. ; Gill, M. John ; Gebo, Kelly A. ; Eron, Joseph J. ; Engels, Eric A. ; Dubrow, Robert ; Crane, Heidi M. ; Brooks, John T. ; Bosch, Ronald J. ; Strickler, Howard. / Invasive cervical cancer risk among HIV-infected women : A North American multicohort collaboration prospective study. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 62, No. 4. pp. 405-413.
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abstract = "Objective: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic human papillomavirus infection-the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. Methods: Data were obtained from HIV-infected and -uninfected female participants in the North American AIDS Cohort Collaboration on Research and Design with no history of ICC at enrollment. Participants were followed from study entry or January 1996 through ICC, loss to follow-up, or December 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios. All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. Results: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 person-years, respectively). HIV-infected women with baseline CD4+ T-cells of $350, 200-349, and ,200 cells per microliter had a 2.3, 3.0, and 7.7 times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend = 0.001). Of the 17 HIV-infected women, medical records for the 5 years before diagnosis showed that 6 had no documented screening, 5 had screening with low-grade or normal results, and 6 had high-grade results. Conclusions: This study found elevated incidence of ICC in HIV infected compared with -uninfected women, and these rates increased with immune suppression.",
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T1 - Invasive cervical cancer risk among HIV-infected women

T2 - A North American multicohort collaboration prospective study

AU - Abraham, Alison G.

AU - D'Souza, Gypsyamber

AU - Jing, Yuezhou

AU - Gange, Stephen J.

AU - Sterling, Timothy R.

AU - Silverberg, Michael J.

AU - Saag, Michael S.

AU - Rourke, Sean B.

AU - Rachlis, Anita

AU - Napravnik, Sonia

AU - Moore, Richard D.

AU - Klein, Marina B.

AU - Kitahata, Mari M.

AU - Kirk, Gregory D.

AU - Hogg, Robert S.

AU - Hessol, Nancy A.

AU - Goedert, James J.

AU - Gill, M. John

AU - Gebo, Kelly A.

AU - Eron, Joseph J.

AU - Engels, Eric A.

AU - Dubrow, Robert

AU - Crane, Heidi M.

AU - Brooks, John T.

AU - Bosch, Ronald J.

AU - Strickler, Howard

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Objective: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic human papillomavirus infection-the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. Methods: Data were obtained from HIV-infected and -uninfected female participants in the North American AIDS Cohort Collaboration on Research and Design with no history of ICC at enrollment. Participants were followed from study entry or January 1996 through ICC, loss to follow-up, or December 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios. All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. Results: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 person-years, respectively). HIV-infected women with baseline CD4+ T-cells of $350, 200-349, and ,200 cells per microliter had a 2.3, 3.0, and 7.7 times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend = 0.001). Of the 17 HIV-infected women, medical records for the 5 years before diagnosis showed that 6 had no documented screening, 5 had screening with low-grade or normal results, and 6 had high-grade results. Conclusions: This study found elevated incidence of ICC in HIV infected compared with -uninfected women, and these rates increased with immune suppression.

AB - Objective: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic human papillomavirus infection-the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. Methods: Data were obtained from HIV-infected and -uninfected female participants in the North American AIDS Cohort Collaboration on Research and Design with no history of ICC at enrollment. Participants were followed from study entry or January 1996 through ICC, loss to follow-up, or December 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios. All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. Results: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 person-years, respectively). HIV-infected women with baseline CD4+ T-cells of $350, 200-349, and ,200 cells per microliter had a 2.3, 3.0, and 7.7 times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend = 0.001). Of the 17 HIV-infected women, medical records for the 5 years before diagnosis showed that 6 had no documented screening, 5 had screening with low-grade or normal results, and 6 had high-grade results. Conclusions: This study found elevated incidence of ICC in HIV infected compared with -uninfected women, and these rates increased with immune suppression.

KW - HIV-infection

KW - Human papillomavirus

KW - Immunosuppression

KW - Invasive cervical cancer

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