Incidence of invasive cervical cancer in a cohort of HIV-seropositive women before and after the introduction of highly active antiretroviral therapy

To assess whether the incidence of invasive cervical cancer (ICC) has chang ed as a result of highly active antiretroviral therapy (HAART), we conducte d a prospective cohort study on the incidence of ICC before and after the i ntroduction of HAART among Italian women with a known duration of HIV infec tion. We estimated the incidence per 1000 person years of ICC as a first AI DS-defining disease for the periods 1981 through 1991, 1992 through 1995, a nd 1996 through 1998. We also estimated the incidence of other first AIDS-d efining diseases. Kaplan-Meier and Cox models were applied to compare the p eriods 1981 through 1995 and 1996 through 1998 in terms of cumulative incid ence and relative hazards (RHs). The analysis included 483 women (median fo llow-up: 7 years). In the period 1981 through 1995, a trend of increase was observed in the incidence of ICC and other AIDS-defining diseases; this tr end has continued only for ICC, whereas the incidence of other AIDS-definin g diseases has decreased since 1996. Compared with 1981 through 1995, the R H of ICC for 1996 through 1998 was 7.41 (95% confidence interval [CI]: 1.21 -45.44); when adjusting for age at HIV seroconversion, the RH decreased to 4.75 (95% CI: 0.80-28.24). It remains to be determined whether the continue d increase in ICC incidence after the introduction of HAART is attributable to a decreasing competitive mortality from other AIDS-defining diseases am ong HIV-infected women.