Changes in The Burden of HIV-Related Cervical Cancer Over A Decade in Côte d’Ivoire

BACKGROUND Major improvements have occurred in access to antiretroviral treatment (ART) and invasive cervical cancer (ICC) prevention of HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associate with HIV infection in women with ICC in Côte d’Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d’Ivoire during the 2009-2011 and 2018-2020 periods. During both periods, women diagnosed with ICC were systematically tested for HIV. A common questionnaire was administered to collect demographic information, ICC risk factors, cancer stage (FIGO) and HIV characteristics (ART use, last known CD4 count) for those screened positive. Characteristics of HIV-related ICC were compared between the time periods and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariate logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed, with median [IQR] age at ICC diagnosis of 49 [40-57] years and 51 [43-60] years (p=0.01), respectively. The estimated HIV prevalence was 24.5% and 21.9% (p=0.53), respectively. An advanced FIGO stage (III, IV) was documented in 74.5% and 76.2% of women during these two time periods (p=0.72). In HIV-infected women, access to ART increased from to 2.8% to 73.8% (p<10 -4 ) and median CD4 cell count from 285 [IQR 250 – 441] to 492 [IQR 377 – 833] cells/mm 3 (p=0.03) between the two time periods. In Women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (FIGO I/II stage) [aOR=2.2 (95%CI 1.1-4.4)] and with higher ICC diagnosis through a systematic screening [aOR=10.5 (95%CI 2.5-45.5)]. CONCLUSIONS Despite an improved access to ART in Côte d’Ivoire, the proportion of HIV-infected women diagnosed with ICC remains high in 2020. HIV-infected women diagnosed with ICC in 2018-2020 presented with less advanced stage and a higher access to ICC screening at diagnosis compared to their uninfected counterparts suggesting an enhanced access to early ICC diagnosis.