Background: To determine the incidence of invasive cervical cancer (ICC) in a cohort of U.S. women infected with human immunodeficiency virus (HIV) or at risk for infection.

Methods: In a national multi-center cohort study, the Women’s Interagency HIV Study, 2,133 women (463 HIV seronegative, 1,662 HIV seropositive, and 8 seroconverters) were followed prospectively from October 1994 through September 2001. Women with a history of cervical cancer or hysterectomy were excluded. Cervical cytology was obtained at 6-month intervals, with a colposcopy referral threshold of atypia. Cervical disease treatment was individualized. ICC diagnoses obtained from study databases and regional cancer registries were confirmed by a gynecologic pathologist.

Results: No cases of invasive cervical cancer were observed in HIV seronegative women during 2,380 yrs of observation, yielding an incidence rate of 0/10,000 woman-yrs. During 8,260 woman-yrs of observation, 8 cases of cervical cancer were identified in HIV-seropositive women by registry review and analysis of WIHS databases, but only 2 were confirmed, the remainder being coding errors (n = 3) or pre-invasive lesions (n = 3), yielding an incidence rate of 2.4/10,000 woman-yrs. The difference in incidence rates between HIV-seropositive and seronegative women was not significant (1-sided p = 0.60).

Conclusions: The ICC incidence rate in U.S. women with HIV participating in a regular cancer prevention program was not significantly greater than that among at-risk HIV seronegative women.