Cervical cancer epidemiology among HIV-infected women in North America

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MEET I N G ABS T R A CTS Open Access
Cervical cancer epidemiology among HIV-infected
women in North America
Gypsyamber DSouza
1*
, Yuezhou Jing
1
, Howard Strickler
10
, Michael Silverberg
2
, Eric Engels
3
, Ronald Bosch
4
,
John T Brooks
5
, Robert Dubrow
6
, Joseph Eron
7
, Kelly Gebo
8
, M J Gill
9
, Bob Hogg
11
, Mari Kitahata
12
, Marina Klein
13
,
Richard Moore
8
, Sean Rourke
14
, Alison G Abraham
1
From 12
th
International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies
(ICMAOI)
Bethesda, MD, USA. 26-27 April, 2010
Background
Initial studies suggest immunosuppression may be asso-
ciated with the increased rates of precancerous cervical
lesions observed in HIV-infected compared with HIV-
uninfected individuals, but few studies have large
enough populations to study the effect on invasive can-
cer. To characterize the incidence of cervical cancer
among HIV-infec ted women in the HAART era, we
examined data from the NA-ACCORD HIV cohort
collaboration of IeDEA.
Materials and methods
This analysis includes data from 13 North American
cohorts of HIV-infected women that collected clinically
confirmed or cancer registry-linked data on invasive cer-
vical cancer. Cervical cancer-free women were followed
from the first HAART era CD4+ measurement (1996
onwards) until the earliest of: cervical cancer diagnosis,
lost to followup, death, or Decembe r 2007. Incidence
rate overall, by calendar period, and by first CD4+ cell
count after 1995 (baseline ) w ere sta ndardized for age
using the 2000 U.S. standard population.
Results
Among the 16,467 HIV-infected women free of disease
at baseline, 1 02 cases of i nvasive cervic al cancer w ere
reported, yielding an age-standardized incidence rate of
114 per 100,000 p erson-years (95% CI: 88 139). O f
those ca ses, 40 (39% ) were HAART-naïve at the time o f
diagnosis. Among women 39, 40-49, and 50 years of
age the incidence rates were 122, 142, and 89 per
100,000 person-years, respectively. The age-standardized
incidence rates by calendar periods for 1996-1999, 2000-
2003, and 2004-2007 were 133, 152, and 87 per 100,000
person-years, respectively, showing no trend. The age-
standardized incidence rates by baseline CD4+ cate-
gories of >350, 200-350 and <200 cells/μL were 68, 113,
and 185, respectively, indicating an i ncreasing rate with
declining CD4+ cell count (P
trend
<0.001). Among 13,716
HIV-negative women free of disease in these coho rts,
there were 10 invasive cervical cancers for an incidence
of 12.3 per 100,000 person-years (95% CI 6.6-23), similar
to the age-adjusted SEER population incidence of
8.2 per 100,000 person-years.
Conclusions
In this large c ollaboration of North American HIV
cohorts, the estimate of cervical can cer incidence was
almost 10-fold higher among HIV-infected than unin-
fected women in these cohorts. Although an ef fect of
increased s exual risk-taking in HIV-infected women
and/or differences in screening cannot be excluded, the
strong association with lower baseline CD4+ cell count
suggests a single low CD4 measurement may predict
increased cervical cancer risk. It is unclear whether
improvements in HIV-therapies during the HAART era
have influenced cervical cancer rates; although no signif-
icant trend in incidence was observed over time, a
decrease was observed in 2004-07.
Acknowledgements
This work is presented on behalf of the North American AIDS Cohort
Collaboration on Research and Design (NA-ACCORD) of IeDEA.
*Correspondence: gdsouza@jhsph.edu
1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA
Full list of author information is available at the end of the article
DSouza et al. Infectious Agents and Cancer 2010, 5(Suppl 1):A9
http://www.infectagentscancer.com/content/5/S1/A9
© 2010 DSouza et al; licensee BioMed Central Ltd.
Page 1
This article has been published as part of Infectious Agents and Cancer
Volume 5 Supplement 1, 2010: Proceedings of the 12
th
International
Conference on Malignancies in AIDS and Other Acquired
Immunodeficiencies (ICMAOI). The full contents of the supplement are
available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.
Author details
1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA.
2
Kaiser Permanente Northern California, Oakland,
CA, USA.
3
Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda,
MD, USA.
4
Department of Biostatistics, Harvard University, Boston, MA, USA.
5
Centers for Disease Control and Prevention, Atlanta, GA, USA.
6
Division of
Chronic Disease Epidemiology Yale University, New Haven, CT, USA.
7
Division
of Infectious Diseases, School of Medicine, University of North Carolina,
Chapel Hill, NC, USA.
8
Department of Medicine, Johns Hopkins School of
Medicine, Baltimore, MD, USA.
9
Department of Medicine, University of
Calgary, Calgary, Canada.
10
Department of Epidemiology, University of
California at San Francisco, San Francisco, CA, USA.
11
BC Centre for
Excellence in HIV/AIDS, Vancouver, Canada.
12
Department of Medicine,
University of Washington, Seattle, WA, USA.
13
McGill University, Montreal,
Canada.
14
Department of Psychiatry, University of Toronto, Toronto, Canada.
Published: 11 October 2010
doi:10.1186/1750-9378-5-S1-A9
Cite this article as: DSouza et al.: Cervical cancer epidemiology among
HIV-infected women in North America. Infectious Agents and Cancer 2010
5(Suppl 1):A9.
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DSouza et al. Infectious Agents and Cancer 2010, 5(Suppl 1):A9
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  • 7 Division of Infectious Diseases 10 Department of Epidemiology, University of California at San Francisco. . 2010-11.5-9.