Human papillomavirus-associated cervical cytologic abnormalities among women with or at risk of infection with human immunodeficiency virus

Ann Duerr, Burney Kieke, Dora Warren, Keerti Shah, Robert D. Burk, Jeffrey F. Peipert, Paula Schuman, Robert S. Klein

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Correlates of abnormal human immunodeficiency virus cervical cytologic findings were examined among women infected with human immunodeficiency virus and uninfected women. STUDY DESlGN: We performed a cross-sectional analysis of baseline data on demographically similar women with infection or risk factors for it. RESULTS: Among 1050 women without hysterectomy, squamous intraepithelial lesions were more common among women infected with human immunodeficiency virus than among uninfected women (18.8% vs 5.3%; P < .001). In multivariate analysis the association of squamous intraepithelial lesions with human papillomavirus infection was strong; adjusted prevalence ratios were 27 for high-risk, 25 for intermediate-risk, and 10 for lowrisk types (95% confidence intervals, 12-58, 12-54, and 4-25, respectively). Much lower adjusted prevalence ratios were seen for the only other factor significantly associated with squamous intraepithelial lesions, namely, infection with human immunodeficiency virus in conjunction with a reduced CD4 + cell count. Adjusted prevalence ratios were 1.9 for CD4 + cell counts <200 and 1.6 for CD4 + cell counts between 200 and 500 (95% confidence intervals, 1.2-3.0 and 1.0-2.5, respectively). Adjusted attributable fractions calculated for this study population indicated that if both human immunodeficiency virus and human papillomavirus were removed, 47.6% of the observed lesions with atypical squamous cells of uncertain significance and 93.4% of the observed squamous intraepithelial lesions would be prevented. CONCLUSlON: Squamous intraepithelial lesions are more common among human immunodeficiency virus-infected women and are associated most commonly with high- and intermediate-risk human papillomavirus types and secondarily with human immunodeficiency virus-associated immune compromise.

Original languageEnglish (US)
Pages (from-to)584-590
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume184
Issue number4
DOIs
StatePublished - 2001

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HIV
Infection
CD4 Lymphocyte Count
Confidence Intervals
Papillomavirus Infections
Hysterectomy
Multivariate Analysis
Cross-Sectional Studies
Squamous Intraepithelial Lesions of the Cervix
Population

Keywords

  • Cervical cytologic abnormalities
  • Human immunodeficiency virus
  • Human papillomavirus

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Human papillomavirus-associated cervical cytologic abnormalities among women with or at risk of infection with human immunodeficiency virus. / Duerr, Ann; Kieke, Burney; Warren, Dora; Shah, Keerti; Burk, Robert D.; Peipert, Jeffrey F.; Schuman, Paula; Klein, Robert S.

In: American Journal of Obstetrics and Gynecology, Vol. 184, No. 4, 2001, p. 584-590.

Research output: Contribution to journalArticle

Duerr, Ann ; Kieke, Burney ; Warren, Dora ; Shah, Keerti ; Burk, Robert D. ; Peipert, Jeffrey F. ; Schuman, Paula ; Klein, Robert S. / Human papillomavirus-associated cervical cytologic abnormalities among women with or at risk of infection with human immunodeficiency virus. In: American Journal of Obstetrics and Gynecology. 2001 ; Vol. 184, No. 4. pp. 584-590.
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AB - OBJECTIVE: Correlates of abnormal human immunodeficiency virus cervical cytologic findings were examined among women infected with human immunodeficiency virus and uninfected women. STUDY DESlGN: We performed a cross-sectional analysis of baseline data on demographically similar women with infection or risk factors for it. RESULTS: Among 1050 women without hysterectomy, squamous intraepithelial lesions were more common among women infected with human immunodeficiency virus than among uninfected women (18.8% vs 5.3%; P < .001). In multivariate analysis the association of squamous intraepithelial lesions with human papillomavirus infection was strong; adjusted prevalence ratios were 27 for high-risk, 25 for intermediate-risk, and 10 for lowrisk types (95% confidence intervals, 12-58, 12-54, and 4-25, respectively). Much lower adjusted prevalence ratios were seen for the only other factor significantly associated with squamous intraepithelial lesions, namely, infection with human immunodeficiency virus in conjunction with a reduced CD4 + cell count. Adjusted prevalence ratios were 1.9 for CD4 + cell counts <200 and 1.6 for CD4 + cell counts between 200 and 500 (95% confidence intervals, 1.2-3.0 and 1.0-2.5, respectively). Adjusted attributable fractions calculated for this study population indicated that if both human immunodeficiency virus and human papillomavirus were removed, 47.6% of the observed lesions with atypical squamous cells of uncertain significance and 93.4% of the observed squamous intraepithelial lesions would be prevented. CONCLUSlON: Squamous intraepithelial lesions are more common among human immunodeficiency virus-infected women and are associated most commonly with high- and intermediate-risk human papillomavirus types and secondarily with human immunodeficiency virus-associated immune compromise.

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