Risk factors for cervical precancer and cancer in HIV-infected, HPV-positive rwandan women

Kathryn Anastos, Donald R. Hoover, Robert D. Burk, Antonio Cajigas, Qiuhu Shi, Diljeet K. Singh, Mardge H. Cohen, Eugene Mutimura, Charles Sturgis, William C. Banzhaf, Philip E. Castle

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Abstract

Background: Although cervical cancer is an AIDS-defining condition, infection with human immunodeficiency virus (HIV) may only modestly increase the risk of cervical cancer. There is a paucity of information regarding factors that influence the natural history of human papillomavirus (HPV) in HIV-infected women. We examined factors associated with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in Rwandan women infected with both HIV and HPV (HIV+/HPV+). Methods: In 2005, 710 HIV+ Rwandan women $25 years enrolled in an observational cohort study; 476 (67%) tested HPV+. Each woman provided sociodemographic data, CD4 count, a cervical cytology specimen and cervicovaginal lavage (CVL), which was tested for.40 HPV genotypes by MY09/MY11 PCR assay. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) of associations of potential risk factors for CIN3+ among HIV+/HPV+ women. Results: Of the 476 HIV+/HPV+ women 42 (8.8%) were diagnosed with CIN3+. Factors associated with CIN3+ included $7 (vs. 0-2) pregnancies, malarial infection in the previous six months (vs. never), and $7 (vs. 0-2) lifetime sexual partners. Compared to women infected by non-HPV16 carcinogenic HPV genotypes, HPV16 infection was positively associated and non-carcinogenic HPV infection was inversely associated with CIN3+. CD4 count was significantly associated with CIN3+ only in analyses of women with non-HPV16 carcinogenic HPV (OR = 0.62 per 100 cells/mm3, CI = 0.40-0.97). Conclusions: In this HIV+/HPV+ population, lower CD4 was significantly associated with CIN3+ only in women infected with carcinogenic non-HPV16. We found a trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection; this association should be investigated in a larger group of HIV+/HPV+ women.

Original languageEnglish (US)
Article numbere13525
JournalPLoS One
Volume5
Issue number10
DOIs
StatePublished - 2010

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Papillomaviridae
Human immunodeficiency virus
Viruses
Uterine Cervical Neoplasms
risk factors
HIV
neoplasms
uterine cervical neoplasms
infection
CD4 Lymphocyte Count
odds ratio
Infection
confidence interval
Cytology
Logistic Models
Human papillomavirus 16
Odds Ratio
Genotype
Confidence Intervals
genotype

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Risk factors for cervical precancer and cancer in HIV-infected, HPV-positive rwandan women. / Anastos, Kathryn; Hoover, Donald R.; Burk, Robert D.; Cajigas, Antonio; Shi, Qiuhu; Singh, Diljeet K.; Cohen, Mardge H.; Mutimura, Eugene; Sturgis, Charles; Banzhaf, William C.; Castle, Philip E.

In: PLoS One, Vol. 5, No. 10, e13525, 2010.

Research output: Contribution to journalArticle

Anastos, Kathryn ; Hoover, Donald R. ; Burk, Robert D. ; Cajigas, Antonio ; Shi, Qiuhu ; Singh, Diljeet K. ; Cohen, Mardge H. ; Mutimura, Eugene ; Sturgis, Charles ; Banzhaf, William C. ; Castle, Philip E. / Risk factors for cervical precancer and cancer in HIV-infected, HPV-positive rwandan women. In: PLoS One. 2010 ; Vol. 5, No. 10.
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title = "Risk factors for cervical precancer and cancer in HIV-infected, HPV-positive rwandan women",
abstract = "Background: Although cervical cancer is an AIDS-defining condition, infection with human immunodeficiency virus (HIV) may only modestly increase the risk of cervical cancer. There is a paucity of information regarding factors that influence the natural history of human papillomavirus (HPV) in HIV-infected women. We examined factors associated with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in Rwandan women infected with both HIV and HPV (HIV+/HPV+). Methods: In 2005, 710 HIV+ Rwandan women $25 years enrolled in an observational cohort study; 476 (67{\%}) tested HPV+. Each woman provided sociodemographic data, CD4 count, a cervical cytology specimen and cervicovaginal lavage (CVL), which was tested for.40 HPV genotypes by MY09/MY11 PCR assay. Logistic regression models calculated odds ratios (OR) and 95{\%} confidence intervals (CI) of associations of potential risk factors for CIN3+ among HIV+/HPV+ women. Results: Of the 476 HIV+/HPV+ women 42 (8.8{\%}) were diagnosed with CIN3+. Factors associated with CIN3+ included $7 (vs. 0-2) pregnancies, malarial infection in the previous six months (vs. never), and $7 (vs. 0-2) lifetime sexual partners. Compared to women infected by non-HPV16 carcinogenic HPV genotypes, HPV16 infection was positively associated and non-carcinogenic HPV infection was inversely associated with CIN3+. CD4 count was significantly associated with CIN3+ only in analyses of women with non-HPV16 carcinogenic HPV (OR = 0.62 per 100 cells/mm3, CI = 0.40-0.97). Conclusions: In this HIV+/HPV+ population, lower CD4 was significantly associated with CIN3+ only in women infected with carcinogenic non-HPV16. We found a trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection; this association should be investigated in a larger group of HIV+/HPV+ women.",
author = "Kathryn Anastos and Hoover, {Donald R.} and Burk, {Robert D.} and Antonio Cajigas and Qiuhu Shi and Singh, {Diljeet K.} and Cohen, {Mardge H.} and Eugene Mutimura and Charles Sturgis and Banzhaf, {William C.} and Castle, {Philip E.}",
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T1 - Risk factors for cervical precancer and cancer in HIV-infected, HPV-positive rwandan women

AU - Anastos, Kathryn

AU - Hoover, Donald R.

AU - Burk, Robert D.

AU - Cajigas, Antonio

AU - Shi, Qiuhu

AU - Singh, Diljeet K.

AU - Cohen, Mardge H.

AU - Mutimura, Eugene

AU - Sturgis, Charles

AU - Banzhaf, William C.

AU - Castle, Philip E.

PY - 2010

Y1 - 2010

N2 - Background: Although cervical cancer is an AIDS-defining condition, infection with human immunodeficiency virus (HIV) may only modestly increase the risk of cervical cancer. There is a paucity of information regarding factors that influence the natural history of human papillomavirus (HPV) in HIV-infected women. We examined factors associated with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in Rwandan women infected with both HIV and HPV (HIV+/HPV+). Methods: In 2005, 710 HIV+ Rwandan women $25 years enrolled in an observational cohort study; 476 (67%) tested HPV+. Each woman provided sociodemographic data, CD4 count, a cervical cytology specimen and cervicovaginal lavage (CVL), which was tested for.40 HPV genotypes by MY09/MY11 PCR assay. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) of associations of potential risk factors for CIN3+ among HIV+/HPV+ women. Results: Of the 476 HIV+/HPV+ women 42 (8.8%) were diagnosed with CIN3+. Factors associated with CIN3+ included $7 (vs. 0-2) pregnancies, malarial infection in the previous six months (vs. never), and $7 (vs. 0-2) lifetime sexual partners. Compared to women infected by non-HPV16 carcinogenic HPV genotypes, HPV16 infection was positively associated and non-carcinogenic HPV infection was inversely associated with CIN3+. CD4 count was significantly associated with CIN3+ only in analyses of women with non-HPV16 carcinogenic HPV (OR = 0.62 per 100 cells/mm3, CI = 0.40-0.97). Conclusions: In this HIV+/HPV+ population, lower CD4 was significantly associated with CIN3+ only in women infected with carcinogenic non-HPV16. We found a trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection; this association should be investigated in a larger group of HIV+/HPV+ women.

AB - Background: Although cervical cancer is an AIDS-defining condition, infection with human immunodeficiency virus (HIV) may only modestly increase the risk of cervical cancer. There is a paucity of information regarding factors that influence the natural history of human papillomavirus (HPV) in HIV-infected women. We examined factors associated with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in Rwandan women infected with both HIV and HPV (HIV+/HPV+). Methods: In 2005, 710 HIV+ Rwandan women $25 years enrolled in an observational cohort study; 476 (67%) tested HPV+. Each woman provided sociodemographic data, CD4 count, a cervical cytology specimen and cervicovaginal lavage (CVL), which was tested for.40 HPV genotypes by MY09/MY11 PCR assay. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) of associations of potential risk factors for CIN3+ among HIV+/HPV+ women. Results: Of the 476 HIV+/HPV+ women 42 (8.8%) were diagnosed with CIN3+. Factors associated with CIN3+ included $7 (vs. 0-2) pregnancies, malarial infection in the previous six months (vs. never), and $7 (vs. 0-2) lifetime sexual partners. Compared to women infected by non-HPV16 carcinogenic HPV genotypes, HPV16 infection was positively associated and non-carcinogenic HPV infection was inversely associated with CIN3+. CD4 count was significantly associated with CIN3+ only in analyses of women with non-HPV16 carcinogenic HPV (OR = 0.62 per 100 cells/mm3, CI = 0.40-0.97). Conclusions: In this HIV+/HPV+ population, lower CD4 was significantly associated with CIN3+ only in women infected with carcinogenic non-HPV16. We found a trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection; this association should be investigated in a larger group of HIV+/HPV+ women.

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