Jeny Ghartey1, Andrea Kovacs, Robert D Burk, L Stewart Massad, Howard Minkoff, Xianhong Xie, Gypsyamber Dʼsouza, Xiaonan Xue, D Heather Watts, Alexandra M Levine, Mark H Einstein, Christine Colie, Kathryn Anastos, Isam-Eldin Eltoum, Betsy C Herold, Joel M Palefsky, Howard D Strickler. 1. *Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY; †Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, NY; ‡Department of Pediatrics, University of Southern California, Los Angeles, CA; §Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; ‖Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO; ¶Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; #Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; **Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; ††Department of Health and Human Services, National Institute of Child Health and Human Development, Bethesda, MD; ‡‡Department of Hematology, City of Hope National Medical Center, Duarte, CA; §§Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, DC; ‖‖Department of Pathology, University of Alabama, Birmingham, AL; and ¶¶Department of Medicine, University of California, San Francisco, CA.
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 high-grade 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.
OBJECTIVE: Plasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositivewomen. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia. DESIGN/ METHODS: In an HIV-seropositivewomen's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident high-grade 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-seropositivewomen, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.
Authors: P S Reichelderfer; R W Coombs; D J Wright; J Cohn; D N Burns; S Cu-Uvin; P A Baron; M H Coheng; A L Landay; S K Beckner; S R Lewis; A A Kovacs Journal: AIDS Date: 2000-09-29 Impact factor: 4.177
Authors: H Chakraborty; P K Sen; R W Helms; P L Vernazza; S A Fiscus; J J Eron; B K Patterson; R W Coombs; J N Krieger; M S Cohen Journal: AIDS Date: 2001-03-30 Impact factor: 4.177
Authors: A Kovacs; S S Wasserman; D Burns; D J Wright; J Cohn; A Landay; K Weber; M Cohen; A Levine; H Minkoff; P Miotti; J Palefsky; M Young; P Reichelderfer Journal: Lancet Date: 2001-11-10 Impact factor: 79.321
Authors: J Bremer; M Nowicki; S Beckner; D Brambilla; M Cronin; S Herman; A Kovacs; P Reichelderfer Journal: J Clin Microbiol Date: 2000-07 Impact factor: 5.948
Authors: T V Ellerbrock; J L Lennox; K A Clancy; R F Schinazi; T C Wright; M Pratt-Palmore; T Evans-Strickfaden; C Schnell; R Pai; L J Conley; E E Parrish-Kohler; T J Bush; K Tatti; C E Hart Journal: J Infect Dis Date: 2001-05-30 Impact factor: 5.226
Authors: Megan Justine Huchko; Victoria Woo; Teri Liegler; Anna Leddy; Karen Smith-McCune; George F Sawaya; Elizabeth A Bukusi; Craig R Cohen Journal: J Low Genit Tract Dis Date: 2013-07 Impact factor: 1.925