Age‐specific burden of cervical cancer associated with HIV : A global analysis with a focus on sub‐Saharan Africa (original) (raw)
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International Journal of Cancer, 2021
HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV-and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to agespecific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.
Cervical cancer risk in women living with HIV across four continents: A multicohort study
International Journal of Cancer
Novelty and impact: Our study compares invasive cervical cancer (ICC) rates among women living with HIV who initiated antiretroviral therapy (ART) across different geographic regions. It shows that ICC incidence rates are particularly high in women living with HIV in South Africa or Latin America. ICC prevention through early ART initiation, equitable access to effective cervical cancer screening, and promotion of human papillomavirus vaccination should be key elements of global efforts to reduce cancer-related health inequities.
Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies
BMC Public Health
Introduction Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence. Methods We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1st 2010 and March 31st 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circ...
Cervical cancer risk factors among HIV-infected
2013
Background: Cervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Cervical cancer is an AIDS-defining cancer; however, HIV only marginally increases the risk of cervical pre-cancer and cancer. In this study, we examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria. Methods: A total of 2,501 HIV-positive women participating in the cervical cancer screen-and-treat program in Abuja, Nigeria consented to this study and provided socio-demographic and clinical information. Log-binomial models were used to calculate relative risk (RR) and 95% confidence intervals (95%CI) for the risk factors of cervical pre-cancer and cancer. Results: There was a 6% prevalence of cervical pre-cancer and cancer in the study population of HIV-positive women. The risk of screening positivity or invasive cancer diagnosis reduced wi...
AIDS, 2021
Objective:Recommendations for the age of initiating screening for cervical cancer in women living with HIV (WLHIV) in the United States have not changed since 1995 when all women (regardless of immune status) were screened for cervical cancer from the age of onset of sexual activity, which often occurs in adolescence. By 2009, recognizing the lack of benefit as well as harms in screening young women, guidelines were revised to initiate cervical cancer screening for the general population at age 21. By comparing cervical cancer incidence in young WLHIV to that of the general population, we assessed the potential for increasing the recommended age of initiating cervical cancer screening in WLHIV.Design:We compared age-specific invasive cervical cancer (ICC) rates among WLHIV to the general population in the United States HIV/AIDS Cancer Match Study.Methods:We estimated standardized incidence ratios as the observed number of cervical cancer cases among WLHIV divided by the expected number, standardized to the general population by age, race/ethnicity, registry and calendar year.Results:ICC rates among WLHIV were elevated across all age groups between ages 25–54 (SIR=3.80; 95%CI 3.48, 4.15), but there were zero cases among ages <25.Conclusions:The absence of ICC among WLHIV <25 years supports initiating cervical cancer screening at age 21, rather than adolescence, to prevent cancers in WLHIV at ages with higher risk of ICC.
Texila International Journal of Academic Research, 2023
In 2015 Namibia reported 55 deaths due to cervical cancer, and the prevalence of HIV was 13,3% among adults aged between 15-49. There is an increased risk of cervical cancer among women living with HIV, the prevalence of this type of cancer and the association with risk factors is unknown at the Omaruru Hospital. High prevalence of HPV infection, advanced HIV disease, tobacco, multiple sexual partners, parity, and poor socioeconomic conditions are listed among contributing factors that increase morbidity and mortality of cervical cancer, which can be controlled & cured if diagnosed early. This research aimed to determine the prevalence of cervical Cancer among HIV-positive women on ARVs and assess the risk factors contributing to the emergence of cervix cancer in this population. The approach methodologic used was a retrospective cross-sectional of 49 women randomly selected among those who were done pap smears at the Omaruru ART clinic between August 2016 to August 2017. There was no positive result for cervical cancers found. Hence, the prevalence of HPV was found to be 16,32%, with Cervical dysplasia 3 cases of CIN I and 5 cases of CIN II with no association established with risk factors, and a case of CIN II in a primigravida with multiple sexual partners were found. To conclude, a meaningful analysis with STATA 14 revealed no positive results for cervical cancer from the 49 cases with no risk factors association established,30.61% of negative HPV (30-39 years;28.57% (40-50 years), CIN II aged 30 to 39 years (4%);4% (40-50 years) 2% above 50 years old. The HPV prevalence (16,32%,),3 cases of CIN 1, and 5 cases of CIN II are indicators that more efforts need to be made.
High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi
International journal of STD & AIDS, 2015
Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30-45 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2/3 or cancer). We extracted cervical pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+. We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% ...
BMC infectious diseases, 2010
The association between HIV infection and invasive cervical cancer that has been reported may reflect differential prevalence of human papillomavirus (HPV) infection or uncontrolled confounding. We conducted a case-control study in a West African population to assess the relationship between HIV infection and invasive cervical cancer, taking into account HPV infection and other potential risk factors for cervical cancer. Women with invasive cervical cancer (cases) or normal cervical cytology (controls) were recruited in a hospital-based case-control study in Abidjan, Côte d'Ivoire. Odds ratios and 95% confidence intervals (CI) were estimated in logistic regression analyses controlling for important cofactors. HIV infection was noted in 22/132 (16.7%) cases and 10/120 (8.3%) controls (p = 0.048). High-risk HPV infection was detected in cervical tumor samples from 89.4% of case-participants and in cervical cytology samples in 31.1% of control-participants. In logistic regression a...
Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012)
International journal of cancer, 2018
Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi-ethnic democracy in 1994, HIV epidemic, and the initiation of CC population-based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age-standardised incidence (ASIR) (1994-2009) and mortality rates (ASMR) (2004-2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five-year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age-groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = -0.9%, p-value < 0.001). The ASMR decreased slightly by 0.6% per annum f...