Veteran women living with HIV have increased risk of HPV-associated genital tract cancers

BACKGROUND: Disparities in access to screening often confound observed differences in HPV-associated genital tract cancer (FGTC) incidence between women living with HIV (WLWH) and their HIV-negative counterparts. We aimed to determine if there have been changes in cancer risk among WLWH during the anti-retroviral era in a single-payer health system.

METHODS: We retrospectively selected WLWH and HIV-negative controls receiving care between 1999-2016 at the US Department of Veterans Affairs (VA) and identified FGTC diagnoses via Cancer Registry and ICD-9/10 codes. We extracted demographic and clinical variables from the VA's Corporate Data Warehouse; evaluated incidence rates (IR), incidence rate ratios (IRR), hazard ratios, and 95% confidence intervals (CI) for cancer risk; and conducted survival analyses.

RESULTS: We identified 1,454 WLWH and compared them to 5,816 matched HIV-negative controls. More WLWH developed HPV-associated FGTCs (total n=28 [2.0%]; cervical=22, vulvovaginal=4, and anal/rectal=2) than HIV-negative women (total n=32 [0.6%]; cervical=24, vulvovaginal=5, and anal/rectal=5) (log rank p<0.0001). Cervical cancer IR was >6-fold higher for WLWH (204.2 per 100,000 py [CI 83.8-324.7]) than HIV-negative women (IR = 31.2 per 100,000 py [CI 17.9-44.5]). The IRs for vulvovaginal and anal cancers were also higher in WLWH. Overall, WLWH were more likely to develop HPV-associated FGTCs compared to their HIV-negative counterparts (all log rank p values <0.0001).

CONCLUSIONS: Veteran WLWH are more likely to develop HPV-associated FGTCs despite equal access to health care. Even in single-payer health systems, WLWH continue to require special attention to ensure guideline-based high-risk HPV screening for prevention of FGTCs.