Assessing the relationship between HIV infection and cervical cancer in Côte d'Ivoire: a case-control study.
BACKGROUND
The association between HIV infection and invasive cervical cancer that has been reported may reflect differential prevalence of human papillomavirus (HPV) infection or uncontrolled confounding. We conducted a case-control study in a West African population to assess the relationship between HIV infection and invasive cervical cancer, taking into account HPV infection and other potential risk factors for cervical cancer.


METHODS
Women with invasive cervical cancer (cases) or normal cervical cytology (controls) were recruited in a hospital-based case-control study in Abidjan, Côte d'Ivoire. Odds ratios and 95% confidence intervals (CI) were estimated in logistic regression analyses controlling for important cofactors.


RESULTS
HIV infection was noted in 22/132 (16.7%) cases and 10/120 (8.3%) controls (p = 0.048). High-risk HPV infection was detected in cervical tumor samples from 89.4% of case-participants and in cervical cytology samples in 31.1% of control-participants. In logistic regression analysis, HIV infection was associated with cervical cancer in women with HPV (OR 3.4; 95% CI 1.1-10.8). Among women aged <or= 40 years, risk factors for cervical cancer were high-risk HPV infection (OR 49.3; 95% CI 8.2-295.7); parity > 2 (OR 7.0; 95% CI 1.9-25.7) and HIV infection (OR 4.5; 95% CI 1.5-13.6). Among women aged > 40 years, high-risk HPV infection (OR 23.5; 95% CI 9.1-60.6) and parity > 2 (OR 5.5; 95% CI 2.3-13.4), but association with HIV infection was not statistically significant.


CONCLUSIONS
These data support the hypothesis that HIV infection is a cofactor for cervical cancer in women with HPV infection, and, as in all populations, the need for promoting cervical screening in populations with high prevalence of HIV infection.
Adjorlolo-Johnson
Georgette
G
Projet RETRO-CI, Centers for Disease Control and Prevention, Global HIV/AIDS Program, Abidjan, Côte d'Ivoire. gajohnson@pedaids.org
Unger
Elizabeth R
ER
Boni-Ouattara
Edith
E
Touré-Coulibaly
Kadidiata
K
Maurice
Chantal
C
Vernon
Suzanne D
SD
Sissoko
Marcel
M
Greenberg
Alan E
AE
Wiktor
Stefan Z
SZ
Chorba
Terence L
TL
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D007560:Cote d'Ivoire; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult