Background: Invasive cervical cancer (ICC) continues to be an important cause of morbidity and mortality among women in the U.S. despite the preventable nature of the disease. Approximately 12,800 new cases of invasive cervical cancer were diagnosed in 2000 leading to an estimated 4,600 deaths. Human immunodeficiency virus (HIV) appears to alter the natural history of oncogenesis, but its impact on invasive cervical cancer is not clearly defined.

Methods: We conducted a case-control study in women with low-grade squamous intraepithelial lesions (LSIL, HPV-related dysplasia) to evaluate the association between HIV infection and invasive cervical cancer. Fifty-three (53) cases with ICC and 343 controls with LSIL were drawn from Massachusetts’ female Medicaid recipients, ages 18 to 44 years, who were enrolled continuously for at least 11 months in a managed care plan during the study period, July 1, 1993, through June 30, 1996. Data from Medicaid claims was merged with data from the Massachusetts AIDS surveillance registry. Information from claims data was further supplemented with data from medical records regarding cigarette-smoking status, parity, and CD4⁺ cell counts in HIV-infected women. We modeled HIV infection in three ways and created three different models adjusting for parity, age, treatment intensity, and an age-x parity interaction.

Results: Crude and Adjusted Odds Ratios (OR) and Confidence Intervals (CI) for Pathologically Confirmed Invasive Cervical Cancer.

Conclusions: There was a strong effect of HIV infection on the risk of invasive cervical cancer in women with LSIL (OR = 3.86; 95% CI 1.44–10.33). The effect was more pronounced in HIV⁺ women with an AIDS diagnosis or a CD4 cell count under 200 than in HIV⁺ women without severe immunosuppression or women without known HIV infection.

 

Exposure Category	OR	95% CI	Adj. OR	Adj. 95% CI
All HIV infected vs. HIV not identified	6.17	2.42–15.73	3.86	1.44–10.33
HIV Infected (vs. HIV not identified) with:
Low CD4+ cell count (<200 cells/ul)	15.09	4.36–52.19	11.85	3.21–43.76
High CD4+ cell count (>=200 cells/ul)	1.08	0.13–8.97	0.51	0.06–4.38
HIV Infected (vs. HIV not identified) with:
Diagnosis of AIDS	7.52	2.52–22.46	5.50	1.76–17.12
No diagnosis of AIDS	3.01	0.57–15.98	2.91	0.38–22.58