TY - JOUR
T1 - Cervical cancer risk in women living with HIV across four continents
T2 - A multicohort study
AU - Rohner, Eliane
AU - Bütikofer, Lukas
AU - Schmidlin, Kurt
AU - Sengayi, Mazvita
AU - Maskew, Mhairi
AU - Giddy, Janet
AU - Taghavi, Katayoun
AU - Moore, Richard D.
AU - Goedert, James J.
AU - Gill, M. John
AU - Silverberg, Michael J.
AU - D'Souza, Gypsyamber
AU - Patel, Pragna
AU - Castilho, Jessica L.
AU - Ross, Jeremy
AU - Sohn, Annette
AU - Bani-Sadr, Firouze
AU - Taylor, Ninon
AU - Paparizos, Vassilios
AU - Bonnet, Fabrice
AU - Verbon, Annelies
AU - Vehreschild, Jörg Janne
AU - Post, Frank A.
AU - Sabin, Caroline
AU - Mocroft, Amanda
AU - Dronda, Fernando
AU - Obel, Niels
AU - Grabar, Sophie
AU - Spagnuolo, Vincenzo
AU - Quiros-Roldan, Eugenia
AU - Mussini, Cristina
AU - Miro, José M.
AU - Meyer, Laurence
AU - Hasse, Barbara
AU - Konopnicki, Deborah
AU - Roca, Bernardino
AU - Barger, Diana
AU - Clifford, Gary M.
AU - Franceschi, Silvia
AU - Egger, Matthias
AU - Bohlius, Julia
N1 - Funding Information:
Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver
Funding Information:
We thank all patients, care providers and data managers in the different IeDEA regions and COHERE in EuroCoord. We would also like to acknowledge Kali Tal for her editorial suggestions. More detailed acknowledgements concerning the participating consortia can be found in the Supporting Information. Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute of Mental Health, and the National Institute on Drug Abuse of the U.S. National Institutes of Health (NIH) under Award Number U01AI069924 (Southern Africa), U01AI069907 (Asia-Pacific), U01AI069923 (Caribbean, Central, and South America), and U01AI069918 (North America). The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) was also supported by NIH grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA011602, R01DA012568, R01AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214 and Z01CP010176; contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; grants CBR-86906, CBR-94036, HCP-97105 and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health and National Institute on Drug Abuse. The COHERE study group has received unrestricted funding from Agence Nationale de Recherches sur le SIDA et les H?patites Virales (ANRS), France; HIV Monitoring Foundation, The Netherlands; and the Augustinus Foundation, Denmark. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007?2013) under EuroCoord grant agreement no. 260694. A list of the funders of the participating cohorts can be found at www.COHERE.org. JMM received a personal 80:20 research grant from the Institut d'Investigacions Biom?diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain during 2017?19. JLC was supported by NIH grant K23AI120875. This study was also made possible by the generous support of the American people through the United States Agency for International Development (INROADS USAID-674-A-12-00029) and by grants from the Swiss National Science Foundation (Ambizione-PROSPER PZ00P3_160407 to JB, special project funding grant 174281 to ME). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
Publisher Copyright:
© 2019 UICC
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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/μl 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.
AB - 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/μl 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.
KW - HIV
KW - cervical cancer
KW - cohort study
KW - incidence rate
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U2 - 10.1002/ijc.32260
DO - 10.1002/ijc.32260
M3 - Article
C2 - 31215037
AN - SCOPUS:85067883399
SN - 0020-7136
VL - 146
SP - 601
EP - 609
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 3
ER -