Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women

被引:89
作者
Hessol, Nancy A. [1 ]
Holly, Elizabeth A.
Efird, Jimmy T. [2 ]
Minkoff, Howard [3 ]
Schowalter, Karlene [4 ]
Darragh, Teresa A.
Burk, Robert D. [5 ]
Strickler, Howard D. [5 ]
Greenblatt, Ruth M.
Palefsky, Joel A.
机构
[1] Univ Calif San Francisco, Dept Clin Pharm, San Francisco, CA 94122 USA
[2] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA
[3] SUNY, Hlth Sci Ctr, Brooklyn, NY USA
[4] Cook Cty Hosp, Core Ctr, Chicago, IL 60612 USA
[5] Albert Einstein Coll Med, New York, NY USA
关键词
anal intraepithelial neoplasia; HIV-infection; human papillomavirus; women; HUMAN-PAPILLOMAVIRUS INFECTION; ACTIVE ANTIRETROVIRAL THERAPY; HOMOSEXUAL-MEN; ANOGENITAL CANCER; SEXUAL PRACTICES; INTERAGENCY HIV; CERVICAL-CANCER; HIGH PREVALENCE; NEGATIVE WOMEN; PCR DETECTION;
D O I
10.1097/QAD.0b013e32831cc101
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objectives: To study anal intraepithelial neoplasia and its associations with anal and cervical human papillomavirus (HPV), cervical neoplasia, host immune status, and demographic and behavioral risk factors in women with and at risk for HIV infection. Design: Point-prevalence analysis nested within a prospective Study of women seen at three clinical centers of the Women's Interagency HIV Study. Methods: In 2001-2003 participants were interviewed, received a gynecological examination, anal and cervical cytology testing and, if abnormal, colposcopy-guided or anoscopy-guided biopsy of visible lesions. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV probing. Logistic regression analyses were performed, and odds ratios (ORs) estimated risks for anal intraepithelial neoplasia. Results: Four hundred and seventy HIV-infected and 185 HIV-uninfected women were enrolled. Low-grade anal intraepithelial neoplasia was present in 12% of HIV-infected and 5%, of HIV-uninfected women. High-grade anal intraepithelial neoplasia was present in 9% of HIV-infected and 1%, of HIV-uninfected women. In adjusted analyses among HIV-infected women, the risk factors for low-grade anal intraepithelial neoplasia were younger age [OR-0.59, 95% confidence interval (CI)=0.36-0.97], history of receptive anal intercourse(OR=3.2, 951% CI=1.5-6.8), anal HPV(oncogenic types only OR=11, 95% CI-1.2-103; oncogenic and nononcogenic types OR = 11, 95% CI = 1.3-96), and cervical HPV (oncogenic and nononcogenic types OR = 3.5, 95% CI = 1.1-11). In multivariable analyses among HIV-infected women, the only significant risk factor for high-grade anal intraepithelial neoplasia was anal HPV infection (oncogenic and nononcogenic types OR = 7.6, 95%, CI = 1.5-38). Conclusion: Even in the era of highly active antiviral therapy, the prevalence of anal intraepithelial neoplasia was 16% in HIV-infected women. After controlling for potential confounders, several risk factors for low-grade anal intraepithelial neoplasia differed from risk factors for high-grade anal intraepithelial neoplasia. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
引用
收藏
页码:59 / 70
页数:12
相关论文
共 48 条
[1]   Anal squamous intralepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women:: prevalence and associated factors [J].
Abramowitz, Laurent ;
Benabderrahmane, Dalila ;
Ravaud, Philippe ;
Walker, Francine ;
Rioux, Christophe ;
Lestin, Christine ;
Bouvet, Elisabeth ;
Soule, Jean-Claude ;
Leport, Catherine ;
Duval, Xavier .
AIDS, 2007, 21 (11) :1457-1465
[2]  
ALBERT A, 1984, BIOMETRIKA, V71, P1
[3]  
[Anonymous], 2002, SAS/STAT Users Guide, Version 9
[4]   The Women's Interagency HIV Study: an observational cohort brings clinical sciences to the bench [J].
Bacon, MC ;
von Wyl, V ;
Alden, C ;
Sharp, G ;
Robison, E ;
Hessol, N ;
Gange, S ;
Barranday, Y ;
Holman, S ;
Weber, K ;
Young, MA .
CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY, 2005, 12 (09) :1013-1019
[5]   The Women's Interagency HIV Study [J].
Barkan, SE ;
Melnick, SL ;
Preston-Martin, S ;
Weber, K ;
Kalish, LA ;
Miotti, P ;
Young, M ;
Greenblatt, R ;
Sacks, H ;
Feldman, J .
EPIDEMIOLOGY, 1998, 9 (02) :117-125
[6]   AIDS-Related cancer and severity of immunosuppression in persons with AIDS [J].
Biggar, Robert J. ;
Chaturvedi, Anil K. ;
Goedert, James J. ;
Engels, Eric A. .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2007, 99 (12) :962-972
[7]   Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women [J].
Burk, RD ;
Ho, GYF ;
Beardsley, L ;
Lempa, M ;
Peters, M ;
Bierman, R .
JOURNAL OF INFECTIOUS DISEASES, 1996, 174 (04) :679-689
[8]   Carcinogenicity of human papillomaviruses [J].
Cogliano, V ;
Baan, R ;
Straif, K ;
Grosse, Y ;
Secretan, B ;
El Ghissassi, F .
LANCET ONCOLOGY, 2005, 6 (04) :204-204
[9]   Effect of HIV infection on the natural history of anal human papillomavirus infection [J].
Critchlow, CW ;
Hawes, SE ;
Kuypers, JM ;
Goldbaum, GM ;
Holmes, KK ;
Surawicz, CM ;
Kiviat, NB .
AIDS, 1998, 12 (10) :1177-1184
[10]   Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer [J].
Daling, JR ;
Madeleine, MM ;
Johnson, LG ;
Schwartz, SM ;
Shera, KA ;
Wurscher, MA ;
Carter, JJ ;
Porter, PL ;
Galloway, DA ;
McDougall, JK .
CANCER, 2004, 101 (02) :270-280