title: Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population.
abstract: OBJECTIVE
  Women living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). A recent publication found that WLWH in Denmark attend the national ICC screening programme less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark compared with that in women in the general population.
  
  
  METHODS
  We studied a nationwide cohort of WLWH and a cohort of 15 age-matched women per WLWH from the general population for the period 1999-2010. Pathology samples were obtained from The Danish Pathology Data Bank, which contains nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology result to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.
  
  
  RESULTS
  We followed 1140 WLWH and 17 046 controls with no prior history of ICC or hysterectomy for 9491 and 156 865 person-years, respectively. Compared with controls, the overall incidences of CIN1 or worse (CIN1+), CIN2+ and CIN3+, but not ICC, were higher in WLWH and predicted by young age and a CD4 count < 200 cells/μL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, when we compared subgroups of WLWH and controls where women in both groups were adherent to the national ICC screening programme and had a normal baseline cytology, incidences of CIN and ICC were comparable.
  
  
  CONCLUSIONS
  Overall, WLWH developed more cervical disease than controls. Yet, in WLWH and controls adherent to the national ICC screening programme and with normal baseline cytology, incidences of CIN and ICC were comparable.
authors.affiliation: Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Thorsteinsson
authors.affiliation: Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Ladelund
authors.affiliation: Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Jensen-Fangel
authors.affiliation: Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: T L
authors.initials: TL
authors.lastname: Katzenstein
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: I Somuncu
authors.initials: IS
authors.lastname: Johansen
authors.affiliation: Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: G
authors.initials: G
authors.lastname: Pedersen
authors.affiliation: Department of Pathology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Junge
authors.affiliation: Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Helleberg
authors.affiliation: Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Storgaard
authors.affiliation: Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Obel
authors.affiliation: Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: A-M
authors.initials: AM
authors.lastname: Lebech
mesh_terms: D000328:Adult; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D012042:Registries; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*
keywords: HIV; cervical cancer; cervical intraepithelial neoplasia; highly active antiretroviral therapy; screening