Cervical Squamous Cell Carcinoma Rates Significantly Higher in Women Living With HIV

Pink ribbon – Red ribbon (isolated with clipping path) on symbolic color bow for HIV AIDS and breast, cervical cancer disease awareness
Researchers assessed whether the risk of cervical cancer, which is elevated in women living with HIV, is also higher across histologic subtypes.

Although the rate of cervical adenocarcinoma was found to be only modestly increased in women living with HIV (WLH) when compared with women without HIV, the rate of cervical squamous cell carcinoma (SCC) was 3.6 times higher in WLH, according to study results published in Clinical Infectious Disease.

Using linked data from 12 US HIV and cancer registries from 1996 to 2016, researchers compared the incidence and survival rates of cervical adenocarcinoma and SCC cervical cancer subtypes in WLH vs women without HIV. 

Of the 62,615 women with cervical cancer, 609 were WLH. There were 54,852 women with cervical adenocarcinoma or SCC, which included 35 cervical adenocarcinoma and 507 SCC cases in WLH. Compared with women with cervical adenocarcinoma and SCC in the general population, WLH with cervical adenocarcinoma and SCC were younger, more likely to be Black, and more likely to have an unknown tumor stage. When comparing only WLH, those with cervical adenocarcinoma were less likely to be Black (51.4% vs 66.7%) compared with those with SCC, but age was similar between the 2 groups.

Although the incidence of cervical adenocarcinoma was 1.47 times higher (95% CI, 1.03-2.05) in WLH compared with women without HIV, the incidence of SCC was 3.62 times higher in WLH (95% CI, 3.31-3.94).  

Among WLH, White women had a lower rate of SCC than Black women (adjusted rate ratio [aRR], 0.53; 95% CI, 0.38-0.73). The risk for SCC was higher among women who acquired HIV through injection drug use vs heterosexual transmission (aRR, 1.44; 95% CI, 1.17-1.78). Conversely, the risk of cervical adenocarcinoma did not differ significantly among WLH by race or method of HIV acquisition.

The 5-year survival rate was not significantly different between cervical adenocarcinoma and SCC in WLH, but it was qualitatively and significantly different when compared with women without HIV. WLH had a greater risk for death for both cervical adenocarcinoma (hazard ratio [HR], 2.52; 95% CI, 1.53-4.12) and SCC (HR, 2.02; 95% CI, 1.79-2.29), which increased with older age, Black race, regional/distant disease, and unknown stage of disease.

Limitations of this study included lower number of cervical adenocarcinoma cases in WLH. Because the linked dataset has incomplete data regarding the CD4 count, the researchers could not “explore the association between level of immune suppression and incidence of AC.”

Findings from this study suggest that “[cervical adenocarcinoma] and SCC are distinct disease subtypes and that differential treatment strategies may be necessary to improve outcomes,” the researchers concluded.


Rositch AF, Levinson K, Suneja G, et al. Epidemiology of cervical adenocarcinoma and squamous cell carcinoma among women living with HIV compared to the general population in the United States. Clin Infect Dis. Published online June 18, 2021. doi:10.1093/cid/ciab561