Jennifer O Lam1, Elizabeth A Sugar2,3, Ross D Cranston4, Kathleen M Weber5, Robert D Burk6, Dorothy J Wiley7, Susheel Reddy8, Joseph B Margolick9, Howard D Strickler10, Alicia Wentz3, Lisa Jacobson3, Christian L Coles1, Jay H Bream9, Anne F Rositch3, Yingshi Guo11, Weihong Xiao11, Maura L Gillison11, Gypsyamber D'Souza12. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. 4. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 5. Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA. 6. Departments of Pediatrics, Microbiology and Immunology, and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA. 7. School of Nursing, University of California Los Angeles, Los Angeles, CA, USA. 8. Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 9. Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 10. Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA. 11. Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. 12. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. gdsouza2@jhu.edu.
Abstract
PURPOSE: Persistent oral human papillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown. METHODS: Scope® oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infected participants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent versus incident infection, age, HIV status and CD4+ T cell count. RESULTS: Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR 0.75, 95% CI 0.57-0.99), anxiolytics/sedatives (HR 0.78, 95% CI 0.63-0.96) and antidepressants (HR 0.82, 95% CI 0.67-0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR 0.67, 95% CI 0.49-0.91), but not HIV-uninfected participants (p-interaction = 0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR 0.75, 95% CI 0.57-0.99), and when restricted to only HIV-infected participants (aHR 0.66, 95% CI 0.48-0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance. CONCLUSIONS: Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.
PURPOSE: Persistent oral humanpapillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown. METHODS: Scope® oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infectedparticipants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent versus incident infection, age, HIV status and CD4+ T cell count. RESULTS: Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR 0.75, 95% CI 0.57-0.99), anxiolytics/sedatives (HR 0.78, 95% CI 0.63-0.96) and antidepressants (HR 0.82, 95% CI 0.67-0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR 0.67, 95% CI 0.49-0.91), but not HIV-uninfectedparticipants (p-interaction = 0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR 0.75, 95% CI 0.57-0.99), and when restricted to only HIV-infectedparticipants (aHR 0.66, 95% CI 0.48-0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance. CONCLUSIONS: Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.
Authors: Kevin P High; Mark Brennan-Ing; David B Clifford; Mardge H Cohen; Judith Currier; Steven G Deeks; Sherry Deren; Rita B Effros; Kelly Gebo; Jörg J Goronzy; Amy C Justice; Alan Landay; Jules Levin; Paolo G Miotti; Robert J Munk; Heidi Nass; Charles R Rinaldo; Michael G Shlipak; Russell Tracy; Victor Valcour; David E Vance; Jeremy D Walston; Paul Volberding Journal: J Acquir Immune Defic Syndr Date: 2012-07-01 Impact factor: 3.731
Authors: Nicoletta Provinciali; Matteo Lazzeroni; Massimiliano Cazzaniga; Franco Gorlero; Barbara K Dunn; Andrea DeCensi Journal: Expert Opin Drug Saf Date: 2015-09-11 Impact factor: 4.250
Authors: Gypsyamber D'Souza; Carole Fakhry; Elizabeth A Sugar; Eric C Seaberg; Kathleen Weber; Howard L Minkoff; Kathryn Anastos; Joel M Palefsky; Maura L Gillison Journal: Int J Cancer Date: 2007-07-01 Impact factor: 7.396