LONG-TERM INCIDENCE OF CERVICAL CANCER IN WOMEN WITH HUMAN IMMUNODEFICIENCY VIRUS
Background: The objective of this study was to estimate the incidence of invasive cervical cancer (ICC) in women with human immunodeficiency virus (HIV) and compare it with the incidence in HIV-uninfected women.
Methods: In a cohort study of HIV-infected and uninfected women who had Papanicolaou tests obtained every 6 months, pathology reports were retrieved for women who had biopsy results or a self report of ICC. Histology was reviewed when reports confirmed ICC. Incidence rates were calculated and compared with those in HIV-negative women.
Results: After a median follow-up of 10.3 years, 3 ICCs were confirmed in HIV-seropositive women, and none were confirmed in HIV-seronegative women. The ICC incidence rate was not found to be associated significantly with HIV status (HIV-negative women [0 of 100,000 person-years] vs HIV-positive women [21.4 of 100,000 person-years]; P = .59). A calculated incidence rate ratio standardized to expected results from the Surveillance Epidemiology and End Results database that was restricted to HIV-infected Women’s Interagency HIV Study participants was 1.32 (95% confidence interval, 0.27-3.85; P = 0.80).
Conclusions: Among women with HIV in a prospective study that incorporated cervical cancer prevention measures, the incidence of ICC was not significantly higher than that in a comparison group of HIV-negative women.
Keywords: Cervical Cancer, Human Immunodeficiency Virus, Women, Cancer Prevention.
2. Southern SA, Herrington CS. Disruption of cell cycle control by human papillomaviruses with special reference to cervical carcinoma. Int J Gynecol Cancer. 2000; 10:263-274.
3. Kessler M, Jan N, Molle R, Guillemin F. Excess risk of cancer in renal transplant patients. Transpl Int. 2006; 19: 908-914.
4. Strickler HD, Burk RD, Fazzari M, et al. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus (HIV) positive women. J Natl Cancer Inst. 2005; 97:577-586.
5. Massad LS, Riester KA, Anastos KM, et al. Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with human immunodeficiency virus-1. Women’s Interagency HIV Study Group. J Acquir Immune Defic Syndr Hum Retrovirol. 1999; 21:33-41.
6. Massad LS, Ahdieh L, Benning L, et al. Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the Women’s Interagency HIV Study. J Acquir Immune Defic Syndr Hum Retrovirol. 2001; 27:432-442.
7. Ellerbrock TV, Chiasson MA, Bush TJ, et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA. 2000; 283:1031-1037.
8. Delmas MC, Larsen C, van Benthem B, et al; for the European Study Group on Natural History of HIV Infection in Women. Cervical squamous intraepithelial lesions in HIVinfected women: prevalence, incidence and regression. AIDS. 2000; 14:1775-1784.
9. Cubie HA, Seagar AL, Beattie GJ, Monaghan S, Williams AR. A longitudinal study of HPV detection and cervical pathology in HIV infected women. Sex Transm Infect. 2000; 76:256-261.
10. Schuman P, Ohmit SE, Klein RS, et al; for the HIV Epidemiology Research Study Group. Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis. 2003; 188:128-136.
11. Massad LS, Fazzari MJ, Anastos K, et al. Outcomes after treatment of cervical intraepithelial neoplasia among women with human immunodeficiency virus. J Lower Genital Tract Dis. 2007; 11:90-97.
12. [No authors listed] 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992; 41:1-19.
13. Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus- associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst. 2000; 92:1500- 1510.
14. Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001; 285:1736-1745.
15. Gallagher B, Wang Z, Schymura MJ, Kahn A, Fordyce EJ. Cancer incidence in New York State acquired immunodeficiency syndrome patients. Am J Epidemiol. 2001;154:544-556.
16. Serraino D, Carrieri P, Pradier C, et al. Risk of invasive cervical cancer among women with, or at risk for, HIV infection. Int J Cancer. 1999; 82:334-337.
17. Patel P, Hanson DL, Sullivan PS, et al; the Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Intern Med. 2008; 148:728-736.
18. Engels EA, Biggar RJ, Hall HI, et al. Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008; 123:187-194.
19. Massad LS, Seaberg EC, Watts DH, et al. Low incidence of invasive cervical cancer among HIV infected US women in a prevention program. AIDS. 2004; 18:109-113.
20. ter Meulen J, Eberhardt HC, Luande J, et al. Human papillomavirus (HPV) infection, HIV infection, and cervical cancer in Tanzania, East Africa. Int J Cancer. 1992; 51:515- 521.
21. Gichangi P, De Vuyst H, Estambale B, Rogo K, Bwayo J, Temmerman M. HIV and cervical cancer in Kenya. Int J Gynecol Obstet. 2002; 76:55-63.
22. Moodley M. Reduction in prevalence of invasive cervical cancer in KwaZulu-Natal, South Africa: impact of the human immunodeficiency virus epidemic. Int J Gynecol Cancer. 2006; 16:1036-1040.
23. Barkan SE, Melnick SL, Martin-Preston S, et al. The Women’s Interagency HIV Study. Epidemiology. 1998; 9:117-125.
24. Kurman RJ, Solomon D. The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses. New York: Springer- Verlag; 1994.
25. Surveillance, Epidemiology, and End Results (SEER) Program. SEER Public-Use Data (1973-2004). Bethesea, Md: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch (released April 2007, based on the November 2006 submission). Available at: http:// www.seer.cancer.gov. Accessed on November 26, 2008.
26. Inskip H. Standardization methods. In: Gail MH, Benichou J, eds. Encyclopedia of Epidemiologic Methods. New York: John Wiley & Sons, Inc.; 2000:871-884.
27. Newman SC. Biostatistical Methods in Epidemiology. New York: John Wiley & Sons, Inc.; 2001.
28. Minkoff H, Ahdieh L, Massad LS, et al. The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIVinfected women. AIDS. 2001; 15:2157-2164.
29. Soncini E, Zoncada A, Condemi V, Antoni AD, Boccialini E, Soregotti P. Reduction of the risk of cervical intraepithelial neoplasia in HIV-infected women treated with highly active antiretroviral therapy. Acta Biomed. 2007; 78:36-40.
30. Leitao MM, White P, Cracchiolo B. Cervical cancer in patients infected with the human immunodeficiency virus. Cancer. 2008; 112:2683-2689.
31. Cejtin HE, Komanoff E, Massad LS, et al. Adherence to colposcopy among women with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol. 1999; 22:247-252.
32. Massad LS, Seaberg EC, Wright RL, et al. Squamous cervical lesions in women with human immunodeficiency virus. Obstet Gynecol. 2008; 111:1388-1393.
33. Duerr A, Paramsothy P, Jamieson DJ, et al; for the HIV Epidemiology Research Study. Effect of HIV infection on atypical squamous cells of undetermined significance. Clin Infect Dis. 2006; 42:855-861.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open Access).