Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa.
Ahmadaye Ibrahim KhalilTharcisse MpungaFeixue WeiIacopo BaussanoCatherine de MartelFreddie BrayDominik StelzleScott Dryden-PetersonAntoine JaquetMarie-Josèphe HornerOlutosin A AwoludeMario Jesus TrejoWashington MudiniAmr S SolimanMazvita SengayiAnna E CoghillMatthys C van AardtHugo De VuystStephen E HawesNathalie BroutetShona DalalGary M CliffordPublished in: 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 age-specific 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.
Keyphrases
- antiretroviral therapy
- hiv positive
- hiv infected
- hiv testing
- human immunodeficiency virus
- hepatitis c virus
- hiv aids
- men who have sex with men
- polycystic ovary syndrome
- risk factors
- metabolic syndrome
- pregnancy outcomes
- pregnant women
- type diabetes
- adipose tissue
- machine learning
- artificial intelligence
- cervical cancer screening
- high grade
- deep learning