Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire

Abstract

PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% ( P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% ( P < 10−4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 ( P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.

Age‐specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub‐Saharan Africa

“…These studies were all conducted in SSA, and authors were invited to share data on HIV prevalence according to the age groups ≤34, 35 to 44, 45 to 54 and ≥55 years. Relevant data were obtained for 17 series from 13 countries: Botswana, 6 Côte d'Ivoire, 7,8 Kenya, 9,10 Malawi, 11 Mozambique, 12 Nigeria, 13 Rwanda, 4 Senegal, 14 South Africa, 10,15,16 United Republic of Tanzania, 17 Uganda, 18 Zambia 19 and Zimbabwe. 20 We were unsuccessful in obtaining age-stratified data from two additional eligible studies from Malawi.…”

Factors Associated With Precancerous Cervical Lesions in Human Immunodeficiency Virus–Infected Women: A Cross-Sectional Survey in Togo

“… 32 , 33 , 38 It would, therefore, be important to take multiparity into account when assessing the risk of precancerous lesions in women living with HIV. 39 …”

Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study

“…Significant effort to make cancer treatments available and to build practitioners' capacity in cancer surgery and radiotherapy have been made in most of these countries in recent decades 4 . National oncologists and radiotherapists were trained, and technical platforms for cancer management have been recently improved with the creation in 2018 of the first radiotherapy center in Côte d'Ivoire, which adds to the existing surgery and chemotherapy strategies 5 . Although the demand for radio‐chemotherapy and surgery is increasing, their actual accessibility remains globally poorly documented.…”