PONE-D-21-14748

Incidence of cervical, breast and colorectal cancer in people living with HIV between 2010 and 2015

PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Partly

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Reviewer #1: I Don't Know

Reviewer #2: No

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Reviewer #2: No

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Reviewer #1: Title: "Incidence of cervical, breast and colorectal cancer in people living with HIV between 2010 and 2015"

The manuscript presents a comprehensive study on a large study sample, regarding incidence trends for the period 2010-2015 for the three cancers included in the French organized screening program for cancer prevention: BC, CRC and ICC.

The study revealed an expected increased of ICC incidence in WLWH than in women in the general population, and also, present an interesting explanation for lower BC incidence rate.

Regarding ICC, it would be worth mentioned that Pap test is not having optimal sensitivity in detecting precancerous lesions of ICC, both in general population and in WLWH.

Organized national CC screening should be implemented worldwide, not only in France, with clinically validated HPV tests, able to detect HR HPV types.

It is known that in WLWH the risk for developing ICC developing is higher, as some studies detected that the risk for evolution to ICC was correlated with the multiple HR HPV types infections and with the number of sexual partners.

Global elimination of cervical cancer is a prioritized aim of WHO, and this could be achieved by two major strategies: stopping the HPV circulation by vaccination and offering HPV screening to those may have been infected before HPV circulation was stopped.

Reviewer #2: Review PONE-D-21-14748

The study has the good intention to provide statistic data for epidemiologic monitoring of cancers among PLWH due to deficient data on cancer incidence in France since 2009. While the study appears to be sound, the language is unclear, making it difficult to follow. The authors should revise the language to improve the flow and readability of the text. Secondly, the study did not clarify how to assign the cancer case that has double or triple cancer diagnosis during analysis. ICC, BC and CRC are the three most common targeted cancers by the nationally organized cancer-screening program in France. Furthermore, BC as the second common cancer in WLWH and the fifth death cause, the study rarely described and discussed BC data. The last but the most important is that the same study using the same data source: the French Dat’AIDS cohort from 2010 to 2015 (Ref 17) have been published in 2020 with much more comprehensive analysis. Altogether, this study will not have a significant contribution to the field.

Minor points to consider in subsequent versions:

1. Significant numbers should be consistent as 0.00 or 0.0 throughout the manuscript.

2. Be consistent with “CD4 cell count” and“HCV coninfection” not “HCV-coinfection” in the text.

3. Some statistic data in text are not match the data listed in Tables. For example, Page 4: Results: The incidence rate of CRC between 2010 and 2015 was 25.0 [95% confidence interval (CI): 18.6-33.4] (in text) vs 25.0 [18.7-33.5] (in Table 2).

4. Tables are better to use the same format. For example, Table 2: 28.5 [17.5-46.5] vs Table 3: 1.93 [1.18 to 3.14].

5. Page 4: Results: Author represented the standardized incidence ratio of ICC and BC, instead of incidence rate in the manuscript.

6. Page6: “the widespread use of ARV[9,10],” should be “the widespread use of ART[9,10],”

7. Page 13: The numbers in the text do not match with the numbers in Table 1: “and nadir CD4 were 601 [IQR: 413-810] and 223 [IQR: 97-350] cells/mm3, respectively. Median CD4 count was 354 [IQR: 264-627] for patients with ICC, 717 [IQR: 408-913] for patients with BC and 446 [IQR: 271-659] for patients with CRC (Table 1).” VS Table 1 numbers: “and nadir CD4 were 223 [97-350] and 601 [413-810]cells/mm3, respectively. Median CD4 count was 354 [264-627] for patients with ICC, 718 [408-943] for patients with BC and 402 [271-630] for patients with CRC. “The incidence rate of CRC in the whole study population was 25.0 [95% CI: 18.6-33.4]” VS Table2: 25.0 [18.7-33.5].

8. Page 14: Table 2: IR for ICC & HCV coinfection is exactly same as IR for CRC (Women) & HCV coinfection: 59.1 [24.6-142.0]. Is it coincident or miss type the data for cancer case?

9. Page 15: Figure 1 has not been explained/presented well in the manuscript. The conclusion “The incidence rates per calendar year remained relatively stable over the study period for the three different cancers (Figs 1A-1C).” from Figure 1 is contradict with Figure 1 presented.

10. Page 15: The section: “SIR for ICC and BC, overall and according to patient profile”: it is supposed to present SIR data from Table 3. However, “incident rate” was in the text instead. Those are two different analysis definition.

11. Page 15: “The ICC incidence rate in the women in our study population was 93% higher (SIR=1.93; 95% CI, 1.18-3.14) than that in women in the general population (Table 3). However, it was 44% lower (SIR, 0.56, 95% CI: 0.42-0.73) for BC.” The calculation/explanation is needed for the results of 93% higher and 44% lower.

12. Page 16: The study claimed that “This is the first study on incidence trends for the period 2010-2015 for the three cancers included in the French organized screening program for cancer prevention.” The similar study has already published in 2020 as in reference 17.

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Reviewer #1: No

Reviewer #2: No

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Incidence of cervical, breast and colorectal cancers between 2010 and 2015 in people living with HIV in France

PONE-D-21-14748R1

Dear Dr. Carrieri,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Cristian Apetrei, MD, PhD

Academic Editor

PLOS ONE

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