Age at Diagnosis of Preinvasive and Invasive Cervical Neoplasia in South Africa: HIV-Positive Versus HIV-Negative Women

Abstract

Hypothesis:Human immunodeficiency virus-positive women develop invasive cervical cancer at a significantly earlier age than seronegative women. It is hypothesized that this might result from shorter preinvasive stages.Methods:Prospective observational study of histologically diagnosed 398 low-grade (LGSIL), 738 high-grade intraepithelial lesions (HGSIL), and 1048 invasive cancers (IC) in a black South African population. The study comprised of 493 (22.6%) seropositive women and 1691 (77.4%) seronegative women who served as the controls. All were subdivided into 5-years age bands.Results:The mean age at diagnosis of LGSIL and HGSIL was similar in the cases (t= 0.7;P= 0.49) and the controls (t= 1.2;P= 0.22). The mean age at diagnosis of IC was significantly younger in the HIV-seropositive women than in the HIV-seronegative women (t= 14.0;P< 0.0001). The relative age distribution curves of LGSIL, HGSIL, and IC evolved close to each other in the cases. In the seronegative women, there was an 18-year lag between the peak age distribution of HGSIL and IC.Conclusion:Our data support the hypothesis of a shorter preinvasive stage in HIV-positive women.