Abstract

Invasive cervical 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. Golub<sup>5

1</sup>Rio 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 Janeiro. Although 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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