Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women
Linda Ahdieh, Alvaro Muñoz, David Vlahov, Cornelia L. Trimble, Lauren A. Timpson, Keerti Shah
Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ ≥200 and <200 cells/μl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV- participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ ≥200 and <200 cells/μl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.
American journal of epidemiology
https://doi.org/10.1093/oxfordjournals.aje.a010165
Cervical intraepithelial neoplasia
10.1093/oxfordjournals.aje.a010165
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Papillomavirus Infections Medicine & Life Sciences 100%
Cervical Intraepithelial Neoplasia Medicine & Life Sciences 43%
Immunosuppression Medicine & Life Sciences 16%
Baltimore Medicine & Life Sciences 11%
Therapeutic Irrigation Medicine & Life Sciences 10%
Ahdieh, L., Muñoz, A., Vlahov, D., Trimble, C. L., Timpson, L. A., & Shah, K. (2000). Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women. American journal of epidemiology, 151(12), 1148-1157. https://doi.org/10.1093/oxfordjournals.aje.a010165
Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women. / Ahdieh, Linda; Muñoz, Alvaro; Vlahov, David; Trimble, Cornelia L.; Timpson, Lauren A.; Shah, Keerti.
In: American journal of epidemiology, Vol. 151, No. 12, 15.06.2000, p. 1148-1157.
Ahdieh, L, Muñoz, A, Vlahov, D, Trimble, CL, Timpson, LA & Shah, K 2000, 'Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women', American journal of epidemiology, vol. 151, no. 12, pp. 1148-1157. https://doi.org/10.1093/oxfordjournals.aje.a010165
Ahdieh L, Muñoz A, Vlahov D, Trimble CL, Timpson LA, Shah K. Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women. American journal of epidemiology. 2000 Jun 15;151(12):1148-1157. https://doi.org/10.1093/oxfordjournals.aje.a010165
Ahdieh, Linda ; Muñoz, Alvaro ; Vlahov, David ; Trimble, Cornelia L. ; Timpson, Lauren A. ; Shah, Keerti. / Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women. In: American journal of epidemiology. 2000 ; Vol. 151, No. 12. pp. 1148-1157.
@article{e7857996a4434d8186236755e7b74bee,
title = "Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women",
abstract = "Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ ≥200 and <200 cells/μl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV- participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ ≥200 and <200 cells/μl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.",
keywords = "Cervical intraepithelial neoplasia, HIV, Human, Immunosuppression, Papillomavirus",
author = "Linda Ahdieh and Alvaro Mu{\~n}oz and David Vlahov and Trimble, {Cornelia L.} and Timpson, {Lauren A.} and Keerti Shah",
note = "Funding Information: This study was supported in part by the Gustave Martin Innovative Research Fund and the General Clinical Research Center, as well as by grant DA04334 from the National Institute on Drug Abuse and USPHS grant U19 AI38533 from the National Institutes of Health.",
doi = "10.1093/oxfordjournals.aje.a010165",
journal = "American Journal of Epidemiology",
T1 - Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women
AU - Ahdieh, Linda
AU - Muñoz, Alvaro
AU - Vlahov, David
AU - Trimble, Cornelia L.
AU - Timpson, Lauren A.
AU - Shah, Keerti
N1 - Funding Information: This study was supported in part by the Gustave Martin Innovative Research Fund and the General Clinical Research Center, as well as by grant DA04334 from the National Institute on Drug Abuse and USPHS grant U19 AI38533 from the National Institutes of Health.
N2 - Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ ≥200 and <200 cells/μl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV- participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ ≥200 and <200 cells/μl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.
AB - Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ ≥200 and <200 cells/μl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV- participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ ≥200 and <200 cells/μl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.
KW - Cervical intraepithelial neoplasia
KW - Human
U2 - 10.1093/oxfordjournals.aje.a010165
DO - 10.1093/oxfordjournals.aje.a010165
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology