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

Abstract

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 agespecific 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.

Burden of Kaposi sarcoma according to HIV status: A systematic review and global analysis

“…These interactions become clearer, and PAFs more informative, however, when they are combined with the absolute size of the KS burden across different world regions and individual countries. This is an approach we have previously applied to cancers attributable to other infections 16 and for cervical cancer attributable to HIV (for which the PAF was much lower than that for KS) 20,21 …”

Global burden of HPV‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis

“…Similar to prior work for cervical cancer, 41 we present two measures of the burden of HIV‐associated SCCA—SCCA diagnosed among PLWHIV (ie, HIV prevalence among SCCA) and that attributable to HIV (ie, PAF). The burden of HIV‐attributable SCCA represents cases that could be theoretically avoided by HIV prevention.…”

State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI

“…Age‐standardized incidence rates (ASIR) in 2020 by country of (A) HIV‐attributable cervical cancer (reproduced from Ibrahim Khalil et al 51 World Health Organization. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC) and (B) HIV‐attributable Kaposi sarcoma (reproduced from Ibrahim Khalil et al 100 World Health Organization.…”

“…It is therefore predicted that the high age‐standardized cervical cancer incidence observed in largely unscreened women with HIV in SSA 48 should decline with wider and earlier access to ART 49,50 . Currently however, cervical cancer burden in women with HIV in SSA remains high, 9,51 perhaps partly due to sub‐optimal ART use to date. Furthermore, because ART also increases life expectancy, even if age‐standardized incidence rates decrease, the absolute numbers of women with HIV diagnosed with cervical cancer in SSA could still increase further, unless effective public health measures are implemented.…”