Joshi, S., Muwonge, R., Kulkarni, V., Deodhar, K., Mandolkar, M., Lucas, E., & Sankaranarayanan, R. (2019). Incidence of cervical intraepithelial neoplasia in women infected with human immunodeficiency virus (HIV) with no evidence of disease at baseline: Results of a prospective cohort study with up to 6.4 years of follow-up from India. International Journal of Cancer, 144(5), 1082–1091. https://doi.org/10.1002/ijc.31826

ABSTRACT

We report the incidence of cervical intraepithelial neoplasia (CIN) among HIV infected women who did not have any colposcopic or histopathological evidence of CIN at baseline. Of the 1023 women without any CIN at baseline, 855 (83.6%) have been followed up to a maximum of 6.4 years contributing 2875 person years of observation (PYO). Among these 855 women, 54 cases of any CIN were observed resulting in incidence rate of any CIN of 1.9 per 100 PYO. The median time for follow‐up for women with any CIN was 3.0 (IQR 1.6‐3.7) years. The cumulative incidence rate per 100 PYO of CIN 2 or worse lesion in women with HPV 18 infection at baseline was 13.3% (95% CI 5.1‐26.8); in women with HPV 16 infection was 10.8% (95% CI 4.4‐20.9); in women with HPV 31 infection was 4.2% (95% CI 0.9‐11.7); and in women with other high‐risk HPV infections was 5.4% (95% CI 2.6‐9.7). HPV 18 infection at baseline contributed highest frequency of incident CIN 2 or worse lesions followed by HPV 16 infection; however other high‐risk HPV types were also responsible for substantial number of incident CIN. The elevated risk of CIN 2+ disease in the study cohort was non‐significant in women with CD4 count <200, possibly because of the small number of cases. Our results emphasize the need for regular cervical cancer screening of HIV‐infected women and urgent implementation of cervical cancer screening services in HIV programmes in India and other low and middle‐income countries