Περίληψη:
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/mu l 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.
What’s new?
Invasive cervical cancer (ICC) is a significant burden among women
living with human immunodeficiency virus (HIV). Little is known,
however, about geographical differences in ICC rates in women living
with HIV. Here, ICC incidence rates in women who received antiretroviral
therapy (ART) were compared across geographic regions. ICC incidence was
notably high among women living with HIV in South Africa and Latin
America. Five years after ART initiation, ICC incidence remained
elevated for women in these two regions, compared with women in Europe
and North America. Reduced CD4 cell count and older age at ART
initiation were associated with increased ICC risk.
Συγγραφείς:
Rohner, Eliane
Butikofer, Lukas
Schmidlin, Kurt
Sengayi,
Mazvita
Maskew, Mhairi
Giddy, Janet
Taghavi, Katayoun and
Moore, Richard D.
Goedert, James J.
Gill, M. John and
Silverberg, Michael J.
D'Souza, Gypsyamber
Patel, Pragna and
Castilho, Jessica L.
Ross, Jeremy
Sohn, Annette
Bani-Sadr,
Firouze
Taylor, Ninon
Paparizos, Vassilios
Bonnet, Fabrice
and Verbon, Annelies
Vehreschild, Jorg Janne
Post, Frank A. and
Sabin, Caroline
Mocroft, Amanda
Dronda, Fernando
Obel, Niels
and Grabar, Sophie
Spagnuolo, Vincenzo
Quiros-Roldan, Eugenia
and Mussini, Cristina
Miro, Jose M.
Meyer, Laurence
Hasse,
Barbara
Konopnicki, Deborah
Roca, Bernardino
Barger, Diana
and Clifford, Gary M.
Franceschi, Silvia
Egger, Matthias and
Bohlius, Julia
