Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden

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Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a cohort of women living with HIV (WLWH) (n = 893) identified from the Swedish national HIV register and HIV-negative women (n = 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN3+ was 13.1% [95% confidence interval (CI) 8.9–17.2] for WLWH and 2.1% (95% CI 2.0–2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN3+ than HIV-negative (HR 8.8: 95% CI 6.9–11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN3+ compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2–5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN3+ among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia.

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Infection with human immunodeficiency virus (HIV) increases a woman's risk for cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+), especially in regions where access to antiretroviral therapy and cervical screening is limited. Yet, whether CIN3+ risk improves when women with HIV migrate into settings with accessible healthcare is unclear. The present study of women migrants with HIV in Sweden suggests that CIN3+ risk remains high. The data further indicate that birth region affects CIN3+ risk, particularly for women living with HIV who were born in the East. The results highlight the importance of early HIV diagnosis and cervical cancer screening, with special focus on migrants.

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