Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population

• Published in: HIV medicine Vol. 17; no. 1; pp. 7 - 17
• Main Authors: Thorsteinsson, K, Ladelund, S, Jensen‐Fangel, S, Katzenstein, TL, Johansen, I Somuncu, Pedersen, G, Junge, J, Helleberg, M, Storgaard, M, Obel, N, Lebech, A‐M
• Format: Journal Article
• Language: English
• Published: England 01-01-2016
• Subjects: Adult; cervical cancer; cervical intraepithelial neoplasia; Denmark - epidemiology; Early Detection of Cancer; Female; highly active antiretroviral therapy; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Incidence; Prospective Studies; Registries; screening; Uterine Cervical Dysplasia - epidemiology; Uterine Cervical Neoplasms - epidemiology; highly active antiretroviral therapy; screening; HIV; cervical cancer; cervical intraepithelial neoplasia
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12271

Objectives
Women living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). A recent publication found that WLWH in Denmark attend the national ICC screening programme less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark compared with that in women in the general population.
Methods
We studied a nationwide cohort of WLWH and a cohort of 15 age‐matched women per WLWH from the general population for the period 1999–2010. Pathology samples were obtained from The Danish Pathology Data Bank, which contains nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology result to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.
Results
We followed 1140 WLWH and 17 046 controls with no prior history of ICC or hysterectomy for 9491 and 156 865 person‐years, respectively. Compared with controls, the overall incidences of CIN1 or worse (CIN1+), CIN2+ and CIN3+, but not ICC, were higher in WLWH and predicted by young age and a CD4 count < 200 cells/μL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, when we compared subgroups of WLWH and controls where women in both groups were adherent to the national ICC screening programme and had a normal baseline cytology, incidences of CIN and ICC were comparable.
Conclusions
Overall, WLWH developed more cervical disease than controls. Yet, in WLWH and controls adherent to the national ICC screening programme and with normal baseline cytology, incidences of CIN and ICC were comparable.