Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women

Howard Strickler, Joel M. Palefsky, Keerti V. Shah, Kathryn Anastos, Robert S. Klein, Howard Minkoff, Ann Duerr, L. Steward Massad, David D. Celentano, Charles B. Hall, Melissa Fazzari, Susan Cu-Uvin, Melanie Bacon, Paula Schuman, Alexandra M. Levine, Amanda J. Durante, Stephen Gange, Sandra Melnick, Robert D. Burk

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Abstract

Background: Human papillomavirus (HPV) type 16 is etiologically associated with approximately half of all cervical cancers. It is important, therefore, to determine the characteristics that distinguish HPV16 from other HPV types. A preliminary result based on cross-sectional baseline data in the Women's Interagency Human Immunodeficiency Virus (HIV) Study (WIHS) suggested that the prevalence of HPV16 might have a weaker association with immune status in HIV-seropositive women than that of other HPV types. To address this issue, we examined HPV test results from repeated study visits in the WIHS and from an independent study, the HIV Epidemiology Research Study (HERS). Methods: HIV-seropositive women in the WIHS (n = 2058) and in the HERS (n = 871) were assessed semiannually. HPV DNA was detected in cervicovaginal lavage specimens by using polymerase chain reaction assays. Prevalence ratios were used to compare the prevalence of each HPV type in women with the lowest CD4+ T-cell counts (<200 T cells/mm3) with that of women with the highest CD4+ T-cell counts (≥500 T cells/mm3). A summary prevalence ratio for each HPV type (i.e., across visits and studies) was estimated using generalized estimating equations. The association of CD4+ T-cell stratum with type-specific HPV incidence was measured using multivariable Cox regression models. All statistical tests were two-sided. Results: The prevalence ratio for HPV16 was low compared with that of other HPV types at every study visit in both cohorts. The generalized estimating equation summary prevalence ratio for HPV16 (1.25, 95% confidence interval [CI] = 0.97 to 1.62) was the smallest measured, and it was statistically significantly lower than that of all other HPV types combined (P = .01). The association of CD4+ T-cell stratum with HPV16 incidence was also among the smallest measured (hazard ratio = 1.69, 95% CI = 1.01 to 2.81). Conclusions: The prevalent and incident detection of HPV16 is more weakly associated with immune status in HIV-seropositive women than that of other HPV types, suggesting that HPV16 may be better at avoiding the effects of immune surveillance, which could contribute to HPV16's strong association with cervical cancer.

Original languageEnglish (US)
Pages (from-to)1062-1071
Number of pages10
JournalJournal of the National Cancer Institute
Volume95
Issue number14
StatePublished - Jul 16 2003

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Human papillomavirus 16
HIV
T-Lymphocytes
CD4 Lymphocyte Count
Uterine Cervical Neoplasms
Epidemiology
Confidence Intervals
Therapeutic Irrigation
Incidence
Proportional Hazards Models
Research
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women. / Strickler, Howard; Palefsky, Joel M.; Shah, Keerti V.; Anastos, Kathryn; Klein, Robert S.; Minkoff, Howard; Duerr, Ann; Massad, L. Steward; Celentano, David D.; Hall, Charles B.; Fazzari, Melissa; Cu-Uvin, Susan; Bacon, Melanie; Schuman, Paula; Levine, Alexandra M.; Durante, Amanda J.; Gange, Stephen; Melnick, Sandra; Burk, Robert D.

In: Journal of the National Cancer Institute, Vol. 95, No. 14, 16.07.2003, p. 1062-1071.

Research output: Contribution to journalArticle

Strickler, H, Palefsky, JM, Shah, KV, Anastos, K, Klein, RS, Minkoff, H, Duerr, A, Massad, LS, Celentano, DD, Hall, CB, Fazzari, M, Cu-Uvin, S, Bacon, M, Schuman, P, Levine, AM, Durante, AJ, Gange, S, Melnick, S & Burk, RD 2003, 'Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women', Journal of the National Cancer Institute, vol. 95, no. 14, pp. 1062-1071.
Strickler, Howard ; Palefsky, Joel M. ; Shah, Keerti V. ; Anastos, Kathryn ; Klein, Robert S. ; Minkoff, Howard ; Duerr, Ann ; Massad, L. Steward ; Celentano, David D. ; Hall, Charles B. ; Fazzari, Melissa ; Cu-Uvin, Susan ; Bacon, Melanie ; Schuman, Paula ; Levine, Alexandra M. ; Durante, Amanda J. ; Gange, Stephen ; Melnick, Sandra ; Burk, Robert D. / Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women. In: Journal of the National Cancer Institute. 2003 ; Vol. 95, No. 14. pp. 1062-1071.
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title = "Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women",
abstract = "Background: Human papillomavirus (HPV) type 16 is etiologically associated with approximately half of all cervical cancers. It is important, therefore, to determine the characteristics that distinguish HPV16 from other HPV types. A preliminary result based on cross-sectional baseline data in the Women's Interagency Human Immunodeficiency Virus (HIV) Study (WIHS) suggested that the prevalence of HPV16 might have a weaker association with immune status in HIV-seropositive women than that of other HPV types. To address this issue, we examined HPV test results from repeated study visits in the WIHS and from an independent study, the HIV Epidemiology Research Study (HERS). Methods: HIV-seropositive women in the WIHS (n = 2058) and in the HERS (n = 871) were assessed semiannually. HPV DNA was detected in cervicovaginal lavage specimens by using polymerase chain reaction assays. Prevalence ratios were used to compare the prevalence of each HPV type in women with the lowest CD4+ T-cell counts (<200 T cells/mm3) with that of women with the highest CD4+ T-cell counts (≥500 T cells/mm3). A summary prevalence ratio for each HPV type (i.e., across visits and studies) was estimated using generalized estimating equations. The association of CD4+ T-cell stratum with type-specific HPV incidence was measured using multivariable Cox regression models. All statistical tests were two-sided. Results: The prevalence ratio for HPV16 was low compared with that of other HPV types at every study visit in both cohorts. The generalized estimating equation summary prevalence ratio for HPV16 (1.25, 95{\%} confidence interval [CI] = 0.97 to 1.62) was the smallest measured, and it was statistically significantly lower than that of all other HPV types combined (P = .01). The association of CD4+ T-cell stratum with HPV16 incidence was also among the smallest measured (hazard ratio = 1.69, 95{\%} CI = 1.01 to 2.81). Conclusions: The prevalent and incident detection of HPV16 is more weakly associated with immune status in HIV-seropositive women than that of other HPV types, suggesting that HPV16 may be better at avoiding the effects of immune surveillance, which could contribute to HPV16's strong association with cervical cancer.",
author = "Howard Strickler and Palefsky, {Joel M.} and Shah, {Keerti V.} and Kathryn Anastos and Klein, {Robert S.} and Howard Minkoff and Ann Duerr and Massad, {L. Steward} and Celentano, {David D.} and Hall, {Charles B.} and Melissa Fazzari and Susan Cu-Uvin and Melanie Bacon and Paula Schuman and Levine, {Alexandra M.} and Durante, {Amanda J.} and Stephen Gange and Sandra Melnick and Burk, {Robert D.}",
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T1 - Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women

AU - Strickler, Howard

AU - Palefsky, Joel M.

AU - Shah, Keerti V.

AU - Anastos, Kathryn

AU - Klein, Robert S.

AU - Minkoff, Howard

AU - Duerr, Ann

AU - Massad, L. Steward

AU - Celentano, David D.

AU - Hall, Charles B.

AU - Fazzari, Melissa

AU - Cu-Uvin, Susan

AU - Bacon, Melanie

AU - Schuman, Paula

AU - Levine, Alexandra M.

AU - Durante, Amanda J.

AU - Gange, Stephen

AU - Melnick, Sandra

AU - Burk, Robert D.

PY - 2003/7/16

Y1 - 2003/7/16

N2 - Background: Human papillomavirus (HPV) type 16 is etiologically associated with approximately half of all cervical cancers. It is important, therefore, to determine the characteristics that distinguish HPV16 from other HPV types. A preliminary result based on cross-sectional baseline data in the Women's Interagency Human Immunodeficiency Virus (HIV) Study (WIHS) suggested that the prevalence of HPV16 might have a weaker association with immune status in HIV-seropositive women than that of other HPV types. To address this issue, we examined HPV test results from repeated study visits in the WIHS and from an independent study, the HIV Epidemiology Research Study (HERS). Methods: HIV-seropositive women in the WIHS (n = 2058) and in the HERS (n = 871) were assessed semiannually. HPV DNA was detected in cervicovaginal lavage specimens by using polymerase chain reaction assays. Prevalence ratios were used to compare the prevalence of each HPV type in women with the lowest CD4+ T-cell counts (<200 T cells/mm3) with that of women with the highest CD4+ T-cell counts (≥500 T cells/mm3). A summary prevalence ratio for each HPV type (i.e., across visits and studies) was estimated using generalized estimating equations. The association of CD4+ T-cell stratum with type-specific HPV incidence was measured using multivariable Cox regression models. All statistical tests were two-sided. Results: The prevalence ratio for HPV16 was low compared with that of other HPV types at every study visit in both cohorts. The generalized estimating equation summary prevalence ratio for HPV16 (1.25, 95% confidence interval [CI] = 0.97 to 1.62) was the smallest measured, and it was statistically significantly lower than that of all other HPV types combined (P = .01). The association of CD4+ T-cell stratum with HPV16 incidence was also among the smallest measured (hazard ratio = 1.69, 95% CI = 1.01 to 2.81). Conclusions: The prevalent and incident detection of HPV16 is more weakly associated with immune status in HIV-seropositive women than that of other HPV types, suggesting that HPV16 may be better at avoiding the effects of immune surveillance, which could contribute to HPV16's strong association with cervical cancer.

AB - Background: Human papillomavirus (HPV) type 16 is etiologically associated with approximately half of all cervical cancers. It is important, therefore, to determine the characteristics that distinguish HPV16 from other HPV types. A preliminary result based on cross-sectional baseline data in the Women's Interagency Human Immunodeficiency Virus (HIV) Study (WIHS) suggested that the prevalence of HPV16 might have a weaker association with immune status in HIV-seropositive women than that of other HPV types. To address this issue, we examined HPV test results from repeated study visits in the WIHS and from an independent study, the HIV Epidemiology Research Study (HERS). Methods: HIV-seropositive women in the WIHS (n = 2058) and in the HERS (n = 871) were assessed semiannually. HPV DNA was detected in cervicovaginal lavage specimens by using polymerase chain reaction assays. Prevalence ratios were used to compare the prevalence of each HPV type in women with the lowest CD4+ T-cell counts (<200 T cells/mm3) with that of women with the highest CD4+ T-cell counts (≥500 T cells/mm3). A summary prevalence ratio for each HPV type (i.e., across visits and studies) was estimated using generalized estimating equations. The association of CD4+ T-cell stratum with type-specific HPV incidence was measured using multivariable Cox regression models. All statistical tests were two-sided. Results: The prevalence ratio for HPV16 was low compared with that of other HPV types at every study visit in both cohorts. The generalized estimating equation summary prevalence ratio for HPV16 (1.25, 95% confidence interval [CI] = 0.97 to 1.62) was the smallest measured, and it was statistically significantly lower than that of all other HPV types combined (P = .01). The association of CD4+ T-cell stratum with HPV16 incidence was also among the smallest measured (hazard ratio = 1.69, 95% CI = 1.01 to 2.81). Conclusions: The prevalent and incident detection of HPV16 is more weakly associated with immune status in HIV-seropositive women than that of other HPV types, suggesting that HPV16 may be better at avoiding the effects of immune surveillance, which could contribute to HPV16's strong association with cervical cancer.

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