Genital tract HIV RNA levels and their associations with human papillomavirus infection and risk of cervical precancer

Jeny Ghartey, Andrea Kovacs, Robert D. Burk, L. Stewart Massad, Howard Minkoff, Xianhong Xie, Gypsyamber D'Souza, Xiaonan (Nan) Xue, D. Heather Watts, Alexandra M. Levine, Mark H. Einstein, Christine Colie, Kathryn Anastos, Isam Eldin Eltoum, Betsy Herold, Joel M. Palefsky, Howard Strickler

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Plasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia. Design/Methods: In an HIV-seropositive women's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident highgrade squamous intraepithelial lesions (HSIL) subclassified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incidents of severe HSIL were matched to 130 controls by age, CD4+ count, highly active antiretroviral therapy use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects. Results: Risk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable, 2.96; 95% confidence interval: 0.99 to 8.84; Ptrend = 0.03). However, this association became nonsignificant (Ptrend = 0.51) after adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend = 0.02) and persistence of oncogenic HPV (Ptrend = 0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels. Conclusions: These prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical precancer in HIV-seropositive women, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.

Original languageEnglish (US)
Pages (from-to)316-323
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume66
Issue number3
StatePublished - Jul 1 2014

Fingerprint

Papillomavirus Infections
HIV
RNA
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Case-Control Studies
Neoplasms
Carcinogenesis

Keywords

  • Cervical neoplasia
  • Genital tract HIV viral load
  • HPV natural history

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Genital tract HIV RNA levels and their associations with human papillomavirus infection and risk of cervical precancer. / Ghartey, Jeny; Kovacs, Andrea; Burk, Robert D.; Massad, L. Stewart; Minkoff, Howard; Xie, Xianhong; D'Souza, Gypsyamber; Xue, Xiaonan (Nan); Watts, D. Heather; Levine, Alexandra M.; Einstein, Mark H.; Colie, Christine; Anastos, Kathryn; Eltoum, Isam Eldin; Herold, Betsy; Palefsky, Joel M.; Strickler, Howard.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 66, No. 3, 01.07.2014, p. 316-323.

Research output: Contribution to journalArticle

Ghartey, J, Kovacs, A, Burk, RD, Massad, LS, Minkoff, H, Xie, X, D'Souza, G, Xue, XN, Watts, DH, Levine, AM, Einstein, MH, Colie, C, Anastos, K, Eltoum, IE, Herold, B, Palefsky, JM & Strickler, H 2014, 'Genital tract HIV RNA levels and their associations with human papillomavirus infection and risk of cervical precancer', Journal of Acquired Immune Deficiency Syndromes, vol. 66, no. 3, pp. 316-323.
Ghartey, Jeny ; Kovacs, Andrea ; Burk, Robert D. ; Massad, L. Stewart ; Minkoff, Howard ; Xie, Xianhong ; D'Souza, Gypsyamber ; Xue, Xiaonan (Nan) ; Watts, D. Heather ; Levine, Alexandra M. ; Einstein, Mark H. ; Colie, Christine ; Anastos, Kathryn ; Eltoum, Isam Eldin ; Herold, Betsy ; Palefsky, Joel M. ; Strickler, Howard. / Genital tract HIV RNA levels and their associations with human papillomavirus infection and risk of cervical precancer. In: Journal of Acquired Immune Deficiency Syndromes. 2014 ; Vol. 66, No. 3. pp. 316-323.
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AU - Ghartey, Jeny

AU - Kovacs, Andrea

AU - Burk, Robert D.

AU - Massad, L. Stewart

AU - Minkoff, Howard

AU - Xie, Xianhong

AU - D'Souza, Gypsyamber

AU - Xue, Xiaonan (Nan)

AU - Watts, D. Heather

AU - Levine, Alexandra M.

AU - Einstein, Mark H.

AU - Colie, Christine

AU - Anastos, Kathryn

AU - Eltoum, Isam Eldin

AU - Herold, Betsy

AU - Palefsky, Joel M.

AU - Strickler, Howard

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N2 - Objective: Plasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia. Design/Methods: In an HIV-seropositive women's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident highgrade squamous intraepithelial lesions (HSIL) subclassified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incidents of severe HSIL were matched to 130 controls by age, CD4+ count, highly active antiretroviral therapy use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects. Results: Risk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable, 2.96; 95% confidence interval: 0.99 to 8.84; Ptrend = 0.03). However, this association became nonsignificant (Ptrend = 0.51) after adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend = 0.02) and persistence of oncogenic HPV (Ptrend = 0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels. Conclusions: These prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical precancer in HIV-seropositive women, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.

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KW - Genital tract HIV viral load

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