title: Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden.
abstract: Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a cohort of women living with HIV (WLWH) (n = 893) identified from the Swedish national HIV register and HIV-negative women (n = 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN3+ was 13.1% [95% confidence interval (CI) 8.9-17.2] for WLWH and 2.1% (95% CI 2.0-2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN3+ than HIV-negative (HR 8.8: 95% CI 6.9-11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN3+ compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2-5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN3+ among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia.
authors.affiliation: Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.|Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Carlander
authors.affiliation: Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden.
authors.forename: Philippe
authors.initials: P
authors.lastname: Wagner
authors.affiliation: Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Svedhem
authors.affiliation: CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Elfgren
authors.affiliation: Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Westling
authors.affiliation: Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.|Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Sönnerborg
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D015331:Cohort Studies; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D012042:Registries; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000821:virology
keywords: HIV; cervical neoplasia; human papillomavirus; immunodeficiency; migrant