International Journal of Cancer
Volume 139, Issue 7, 2016, Pages 1471-1479

Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden (Article)

Carlander C.* , Wagner P. , Svedhem V. , Elfgren K. , Westling K. , Sönnerborg A. , Sparén P.
  • a Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
  • b Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
  • c Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
  • d CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
  • e Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
  • f Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
  • g Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Abstract

Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a cohort of women living with HIV (WLWH) (n = 893) identified from the Swedish national HIV register and HIV-negative women (n = 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN3+ was 13.1% [95% confidence interval (CI) 8.9–17.2] for WLWH and 2.1% (95% CI 2.0–2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN3+ than HIV-negative (HR 8.8: 95% CI 6.9–11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN3+ compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2–5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN3+ among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia. © 2016 UICC

Author Keywords

Human papillomavirus migrant HIV cervical neoplasia immunodeficiency

Index Keywords

medical record review Africa south of the Sahara Human immunodeficiency virus infection follow up human controlled study priority journal cancer risk cancer screening Sweden immunosuppressive treatment migrant CD4 lymphocyte count female uterine cervix cytology prevalence Article major clinical study adult CD4+ T lymphocyte uterine cervix carcinoma in situ cohort analysis high risk patient cancer incidence
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84978224217&doi=10.1002%2fijc.30188&partnerID=40&md5=9b34c63de4b23f34f3f34724d68bc586
DOI: 10.1002/ijc.30188
ISSN: 00207136
Cited by: 6
Original Language: English