A Comparison of the Natural History of HPV Infection and Cervical Abnormalities among HIV-Positive and HIV-Negative Women in Senegal, Africa

被引:27
作者
Whitham, Hilary K. [1 ]
Hawes, Stephen E. [2 ]
Chu, Haitao [3 ]
Oakes, J. Michael [1 ]
Lifson, Alan R. [1 ]
Kiviat, Nancy B. [4 ]
Sow, Papa Salif [5 ]
Gottlieb, Geoffrey S. [6 ,7 ]
Ba, Selly [5 ]
Sy, Marie P. [5 ]
Kulasingam, Shalini L. [1 ]
机构
[1] Univ Minnesota, Div Epidemiol & Community Hlth, Minneapolis, MN USA
[2] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[3] Univ Minnesota, Div Biostat, Minneapolis, MN USA
[4] Univ Washington, Dept Pathol, Seattle, WA 98195 USA
[5] Univ Dakar, Serv Malad Infectieuses, Dakar, Senegal
[6] Univ Washington, Dept Med, Div Allergy & Infect Dis CERID, Seattle, WA USA
[7] Univ Washington, Dept Global Hlth, Seattle, WA 98195 USA
关键词
HUMAN-IMMUNODEFICIENCY-VIRUS; HUMAN-PAPILLOMAVIRUS INFECTION; SQUAMOUS INTRAEPITHELIAL LESIONS; SUB-SAHARAN AFRICA; ACTIVE ANTIRETROVIRAL THERAPY; SOUTH-AFRICA; WEST-AFRICA; CANCER PREVENTION; COMPETING RISK; NEOPLASIA;
D O I
10.1158/1055-9965.EPI-16-0700
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: There is evidence of an interaction between HIV and human papillomavirus (HPV) resulting in increased HPV-associated morbidity and cancer mortality among HIV-positive women. This study aims to determine how the natural history of cervical HPV infection differs by HIV status. Methods: A total of 1,320women (47% were positive for HIV-1 and/or HIV-2) were followed for an average of two years in Senegal, West Africa between 1994 and 2010. Cytology (with a sub-sample of histology) andHPVDNAtesting were performed at approximately 4-month intervals yielding data from over 7,900 clinic visits. Competing risk modeling was used to estimate rates for transitioning between three clinically relevant natural history stages: Normal, HPV, and HSIL (high-grade squamous intraepithelial lesions). Among HIV-positive women, exploratory univariate analyses were conducted examining the impact of HPV type, infection with multiple HPV types, HIV type, CD4(+) count, and age. Results: HIV-positive women had higher rates of progression and lower rates of regression compared with HIV-negative women (i.e., adverse transitions). HIV-positive women had a 2.55 [95% confidence interval (CI), 1.69-3.86; P < 0.0001] times higher rate of progression from HPV to HSIL than HIV-negative women (with 24-month absolute risks of 0.18 and 0.07, respectively). Among HIV-positive women, HPV-16/18 infection and CD4(+) count <200/mm(3) were associated with adverse transitions. Conclusions: Adverse HIV effects persist throughout HPV natural history stages. Impact: In the limited-resource setting of sub-Saharan Africa where cervical cancer screening is not widely available, the high-risk population of HIV-positive women may be ideal for targeted screening. Cancer Epidemiol Biomarkers Prev; 26(6); 886-94. (C)2017 AACR.
引用
收藏
页码:886 / 894
页数:9
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