cancer among HIV-infected women in the THRio HIV cohort, Rio de Janeiro, Brazil
V. Saraceni1, A.G.F. Pacheco2, S. Cohn3, R.T. Brito1, L.H. Moulton4, S.C. Cavalcante1, R.E. Chaisson5, B. Durovni1, J.E. Golub5
1Rio de Janeiro City Health Secretariat, Rio de Janeiro, Brazil, 2Fiocruz, PROCC, Rio de Janeiro, Brazil, 3Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 4Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, 5John Hopkins University- School of Medicine, Baltimore, United States
Background: HIV-infected women are at a 4-5 times greater risk of developing cervical
intraepithelial neoplasia (CIN), related to persistence of high-risk HPV types.
Invasive cervical cancer (ICC) screening using Pap smears are available free of
charge as a public health policy in Brazil, which could reduce ICC incidence through early management of squamous
intraepithelial lesions and CIN. We
investigated HIV-infected women with probable ICC in THRio cohort to
measure access to Pap smears among this population.
Methods: Among 6,934 women in
the cohort, 60 were initially diagnosed as probable ICC cases. After
investigation consisting of thorough medical record abstraction from charts at
29 public HIV clinics, 15 cases had histologically confirmed ICC. We conducted
a case-control study to investigate factors associated with ICC. Three controls
per case were selected, matched by age and clinic.
Results: Among 15 cases and 42
matched controls, no differences were observed in history of sexually
transmitted infections, confirmed cervical HPV, smoking, CD4 at HIV diagnosis
or exposure to HAART. Cases were more likely to have a Pap smear requested (93%
vs. 67%, p=.04) and to have CIN (100% vs. 10%, p< .001; 93% had CIN grade 3
or cancer in situ). Matched logistic regression did not yield any significant
associated factors for ICC (HAART exposure OR=0.67 (95%CI: 0.08-5.57), smoking
OR=1.42 (95%CI: 0.35-5.83) and CD4 OR=1.0). The prevalence of ICC in the cohort
was 0.2%. The age standardized ICC incidence
rate in this population was 45.8/100,000 women, compared to an incidence of
23.4/100,00 for all of Brazil.
Conclusions: ICC risk is increased
in HIV-infected women in Rio de
ICC prevention policies exist in Brazil, access is low among
HIV-infected women despite their high risk for cervical cancer. Low screening
rates among HIV-infected women may lead to late discovery of cancer, leading to
the high ICC rate seen here.
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