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Cited by 523Cervical Cancer and HPV ResearchViral-associated cancers and disordersHIV/AIDS Research and Interventions

Risk of Human Papillomavirus–Associated Cancers Among Persons With AIDS

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Chaturvedi, Anil K., Madeleine, Margaret M., Biggar, Robert J., Engels, Eric A.·2009·JNCI: Journal of the National Cancer Institute
DOI 10.1093/jnci/djp205PMC PMC2728745
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Abstract

BACKGROUND: Although risk of human papillomavirus (HPV)-associated cancers of the anus, cervix, oropharynx, penis, vagina, and vulva is increased among persons with AIDS, the etiologic role of immunosuppression is unclear and incidence trends for these cancers over time, particularly after the introduction of highly active antiretroviral therapy in 1996, are not well described. METHODS: Data on 499 230 individuals diagnosed with AIDS from January 1, 1980, through December 31, 2004, were linked with cancer registries in 15 US regions. Risk of in situ and invasive HPV-associated cancers, compared with that in the general population, was measured by use of standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). We evaluated the relationship of immunosuppression with incidence during the period of 4-60 months after AIDS onset by use of CD4 T-cell counts measured at AIDS onset. Incidence during the 4-60 months after AIDS onset was compared across three periods (1980-1989, 1990-1995, and 1996-2004). All statistical tests were two-sided. RESULTS: Among persons with AIDS, we observed statistically significantly elevated risk of all HPV-associated in situ (SIRs ranged from 8.9, 95% CI = 8.0 to 9.9, for cervical cancer to 68.6, 95% CI = 59.7 to 78.4, for anal cancer among men) and invasive (SIRs ranged from 1.6, 95% CI = 1.2 to 2.1, for oropharyngeal cancer to 34.6, 95% CI = 30.8 to 38.8, for anal cancer among men) cancers. During 1996-2004, low CD4 T-cell count was associated with statistically significantly increased risk of invasive anal cancer among men (relative risk [RR] per decline of 100 CD4 T cells per cubic millimeter = 1.34, 95% CI = 1.08 to 1.66, P = .006) and non-statistically significantly increased risk of in situ vagina or vulva cancer (RR = 1.52, 95% CI = 0.99 to 2.35, P = .055) and of invasive cervical cancer (RR = 1.32, 95% CI = 0.96 to 1.80, P = .077). Among men, incidence (per 100 000 person-years) of in situ and invasive anal cancer was statistically significantly higher during 1996-2004 than during 1990-1995 (61% increase for in situ cancers, 18.3 cases vs 29.5 cases, respectively; RR = 1.71, 95% CI = 1.24 to 2.35, P < .001; and 104% increase for invasive cancers, 20.7 cases vs 42.3 cases, respectively; RR = 2.03, 95% CI = 1.54 to 2.68, P < .001). Incidence of other cancers was stable over time. CONCLUSIONS: Risk of HPV-associated cancers was elevated among persons with AIDS and increased with increasing immunosuppression. The increasing incidence for anal cancer during 1996-2004 indicates that prolonged survival may be associated with increased risk of certain HPV-associated cancers.

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  • Women living with HIV face a six-to-tenfold increased risk of cervical cancer compared to HIV-negative women.

    “Women living with HIV (WLHIV) face an almost six-to-ten-fold increased risk of cervical cancer compared to HIV-negative women [8–10].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [8]

    Table 2 reports an approximately sixfold risk of invasive cervical cancer (SIR 5.6) among women with AIDS compared with the general population. Its approximately ninefold figure (SIR 8.9) is for in situ cervical cancer, not invasive cancer. The paper does not establish a six-to-tenfold risk for all women living with HIV compared specifically with HIV-negative women. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • India's National AIDS Control Programme includes a network of over 2500 ART centres providing regular care to over a million people living with HIV.

    “which includes a network of over 2500 ART centres (including ART centres, link ART centres, and care support centres) providing regular care to over a million people living with HIV across the country [8, 10, 13].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [8]

    The paper’s Results describe 499,230 people with AIDS in the United States, not India’s HIV-care network. Searches for India’s National AIDS Control Programme, 2,500 ART centres, and care for over a million people found no passage addressing those claims in our copy. (LLM, conf=0.78)

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Research works printed but not linked: 38

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Authors
Chaturvedi, A. K., Madeleine, M. M., Biggar, R. J., & Engels, E. A.
Affiliations
  • National Institutes of Health (US)
  • Statens Serum Institut (DK)
ORCID
Venue
JNCI: Journal of the National Cancer Institute
Publisher
Oxford University Press (OUP)
Published
2009-08-19
Volume
101
Issue
16
Pages
1120-1130
ISSN
  • 0027-8874 (ISSN-L)
  • 1460-2105
DOI
10.1093/jnci/djp205
PMC
PMC2728745
OpenAlex
W1507980006
Cited by
523
References
0
Citations by year
2026: 10 · 2025: 15 · 2024: 31 · 2023: 18 · 2022: 16 · 2021: 25 · 2020: 22 · 2019: 30 · 2018: 39 · 2017: 33 · 2016: 26 · 2015: 43 · 2014: 39 · 2013: 54 · 2012: 47
FWCI
27.43
Type
journal article
Language
en
Open access
Locations
  • JNCI Journal of the National Cancer Institute (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
human papillomavirus, HPV-associated cancers, AIDS, immunosuppression, CD4 count, cervical cancer, anal cancer, oropharyngeal cancer, penile cancer, cancer incidence trends, highly active antiretroviral therapy, carcinoma in situ, cancer screening
MeSH terms
Acquired Immunodeficiency Syndrome, Adult, Aged, Anus Neoplasms, Uterine Cervical Neoplasms, Female, Humans, Male, Middle Aged, Neoplasms, Oropharyngeal Neoplasms, Penile Neoplasms, Research Design, Retrospective Studies, Risk Factors, Time Factors, Tumor Virus Infections, United States, Vaginal Neoplasms, Vulvar Neoplasms, CD4-Positive T-Lymphocytes, HIV Infections, Incidence, Poisson Distribution, Immunocompromised Host, Risk Assessment, CD4 Lymphocyte Count, Antiretroviral Therapy, Highly Active, Papillomavirus Infections, Alphapapillomavirus

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