Invasive cervical cancer as an AIDS-defining illness in Europe

Objective(s): To evaluate the frequency and correlates of invasive cervical cancer (ICC) as an AIDS-defining illness (ADI) in Europe. Design: Statistical analysis of data from: national AIDS surveillance systems of 15 European countries with ≥ 50 female AIDS cases; and from population-based cancer registries of the same nations. Methods: AIDS cases notified between 1993 (when ICC was included among ADI) and 1999 in women aged 20-49 years were taken into consideration. The association between the presence of ICC as an ADI and potential determinants was assessed by calculation of odds ratios (OR) and 95% confidence intervals (CI). Country-specific incidence rates of ICC in women aged 20-49 years were correlated with selected AIDS-associated variables by means of the Pearson correlation coefficient (r). Results: The OR of having ICC as an ADI increased with age and was significantly elevated in southern (3.1) and central (2.5) compared with northern Europe. It was also increased among injecting drug users (IDU; 1.5). The proportion of ICC as ADI was inversely correlated with incidence rates of ICC in the general female population, but directly correlated with the proportion of IDU among female AIDS cases. Conclusions: The frequency of ICC as an ADI in Europe was independent from the background risk of ICC in the general population. It was higher where IDU predominated among female AIDS cases and where population-based ICC screening programs were less effective.