Women with HIV have three times the risk of cervical cancer, finds in large South African study

A South African study of more than 500,000 women found that despite very high antiretroviral coverage, HIV-infected women had approximately 30% lower incidence of cervical cancer than non-HIV women. It was shown to be twice as high. As reported in international cancer journalHIV-infected women developed cervical cancer at a younger age than other women.

HIV contributes to the development of cervical cancer through immunosuppression, which reduces the immune system’s ability to eliminate cells infected with oncogenic human papillomavirus (HPV) strains. HIV also promotes the expression of numerous proteins in cancer-causing HPV strains.

Women living with HIV are at increased risk of acquiring HPV infection and experiencing persistent infection with cancer-causing HPV strains. Women infected with HIV develop precancerous changes in the cervix more quickly and cervical cancer develops more quickly.

The incidence of cervical cancer increases after the age of 40 in women in low-income countries, but some studies show that women with HIV have approximately 10 years more cancer incidence than women without HIV. It has been observed that women tend to develop cervical cancer earlier. More than half of women diagnosed with cervical cancer in southern Africa are infected with HIV, and one study found that 86% of cervical cancer cases in women under 35 in southern Africa It is presumed to be caused by HIV. However, despite these findings, there is a lack of information on age-specific cervical cancer incidence to guide screening policies.

Researchers from the University of Bern and the University of Cape Town surveyed 517,312 women enrolled in South Africa’s private health insurance system between 2011 and 2018 to identify precancerous cellular changes (dysplasia) in the cervix. and cervical cancer incidence were retrospectively analyzed. The study used reimbursement claims for inpatient and outpatient care to estimate the age-specific incidence of each disease in HIV-infected and uninfected women.

HIV-infected women were identified by the presence of at least two different HIV-related indicators in the insurance claims database, including HIV-related laboratory tests, prescription of antiretroviral therapy, and enrollment in a health care provider. aid against aids Clinical management program. Eight percent of women (38,739) were classified as having HIV, and 88 percent were on antiretroviral treatment. The median age of the cohort at baseline was 37 years.

Follow-up (period at risk) began at enrollment in the health insurance scheme or at 18:00.^th Birth date, first HIV index, or January 2011, whichever was later.

During the follow-up period, 3556 women were diagnosed with moderate cervical dysplasia (31% in HIV-infected women). Almost half (46%) of women with moderate dysplasia are between the ages of 25 and 34, and in this age group the risk of developing moderate dysplasia is 24% higher than for women between the ages of 35 and 44. Ta. The peak incidence of moderate dysplasia occurred at age 28 in women without HIV and at age 33 in women with HIV.

Severe dysplasia was diagnosed in 3,417 women (30% were HIV-infected women). Regardless of HIV status, the incidence peaked at her age of 31 years. Carcinoma in situ (700 cases, 29% of whom were HIV-infected women), sometimes referred to as high-grade dysplasia in other studies because it is considered a non-invasive cancer, was diagnosed in 700 women. it was done. Incidence peaked at age 34.

564 women were diagnosed with cervical cancer (23% were HIV-infected). Incidence peaks at age 52 and the risk of being diagnosed with cervical cancer increases with age, so women aged 55 and older are more likely to be diagnosed with cervical cancer than women aged 35 to 44. The sex is approximately doubled.

HIV-infected women had an approximately 3-fold increased risk of developing cervical cancer or carcinoma in situ and approximately 3.5-fold increased risk of developing moderate or severe dysplasia compared with HIV-uninfected women. HIV-infected women remained at high risk for cervical precancers or cervical cancer throughout the follow-up period, despite improved HIV diagnosis rates and increased uptake of antiretroviral therapy.

The study’s researchers say screening HIV-infected women for cervical abnormalities more frequently may have led to more of these symptoms being detected. It also mentions the following points: another study There were no differences in cervical cancer screening rates according to HIV status among women in South Africa.

In contrast to previous studies that suggested that HIV-infected women develop cervical precancerous cancer at a younger age than non-HIV women, this study found no difference in peak age of diagnosis. However, the study found that the peak age of cervical cancer diagnosis was seven years earlier in HIV-infected women than in HIV-uninfected women (49 years vs. 56 years).

Regardless of HIV status, a history of genital warts or other sexually transmitted infections was significantly associated with an increased risk of being diagnosed with any form of dysplasia or cervical cancer.

Researchers said the results may underestimate the association between HIV and cervical precancerous and cervical cancer, as only 15% of women in South Africa have health insurance. It states that there is. Presumably, cervical cancer screening rates are low among uninsured women who use public health facilities, while the incidence of cervical cancer is high in the rest of the population.