Incidence of invasive cervical cancer in a cohort of HIV-infected women before and after the introduction of HAART

The incidence of AIDS-defining diseases has been reported to have decreased since the introduction of highly active antiretroviral therapy (HAART), although the decreases in specific diseases have not been extensively studied.

The greatest decrease in the incidence of AIDS-defining cancers has been in Kaposi’s sarcoma. Although invasive cervical cancer (ICC) has been included as an AIDS-defining disease since 1993 in the European AIDS case definition, reported cases are infrequent. Only 26 cases of AIDS-related ICC have been reported in Europe between 1993 and 1999. According to the investigators, “The objective of the present study was to assess whether the incidence of ICC has changed since the introduction of HAART among women with a known duration of HIV infection.” Utilizing a prospective cohort study-the Italian Seroconversion Study, “a study of HIV-infected individuals for whom the date of seroconversion can be estimated with a certain level of accuracy”-the authors researched the incidence of ICC before and after the introduction of HAART in Italy. The investigators estimated the incidence per 1000 person years of ICC as the first AIDS-defining disease from 1981 through 1991, from 1992 through 1995 and from 1996 to 1998.

The analysis included 483 women. Kaplan-Meier and Cox models were applied to compare the periods of 1981 through 1995 and 1996 through 1998 in terms of cumulative cases and relative hazards (RHs). For full analysis, only two periods were considered: 1981 through 1995 (before the introduction of HAART) and 1996 through 1998 (after the introduction of HAART in Italy). “The median age at HIV seroconversion was 25 years (range 14-51 years). The median duration of follow-up was 7 years (range: 0.1-15 years),” according to the investigators. During the study period, 133 women developed AIDS. Among these, 6 (4.5 percent) were diagnosed with ICC as the first AIDS- defining disease. Of these 6 women, 4 were diagnosed with ICC after 1995. Two had undergone monotherapy, 2 had undergone double therapy and 1 had undergone HAART; 1 had not undergone antiretroviral therapy.

According to the report, “For none of the 6 cases were opportunistic infections or malignancies other than ICC observed during follow-up.” In the period 1981 to 1995, an increase was observed in the incidence of ICC and other AIDS-defining diseases. The trend continued only for ICC since 1996. Compared with 1981 through 1995, the RH of ICC for 1996-1998 was 7.41. When adjusting for age at HIV seroconversion, the RH decreased to 4.75. According to the authors, it remains to be seen whether the increase in ICC after HAART is attributable to a decreasing competitive mortality from other AIDS-defining diseases, or whether, in fact, ICC “may not be greatly influenced by severe immunosuppression, stressing the importance of clarifying the role of immunosuppression on the development of ICC and thus of determining the direct effect of HAART on ICC.”

Maria Dorrucci; Barbara Suligoi; Diego Serraino; Umberto Tirelli; Giovanni Rezza; Italian HIV-Seroconversion Study. Journal of Acquired Immune Deficiency Syndromes (01.04.01) 2001; 26: 377-380.