Incidence of cervical precancers among HIV-seropositive women - 07/01/15

Doi : 10.1016/j.ajog.2014.12.003

L. Stewart Massad, MD ^a,^⁎ , Xianhong Xie, PhD ^b, Gypsyamber D’Souza, PhD ^f, Teresa M. Darragh, MD ^g, Howard Minkoff, MD ^e, Rodney Wright, MD ^c,^d, Christine Colie, MD ⁱ, Lorraine Sanchez-Keeland, PA-C ^h, Howard D. Strickler, MD ^b
^a Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
^b Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
^c Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY
^d Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY
^e Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
^f Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
^g Departments of Pathology and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
^h Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA
ⁱ Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC

^∗Corresponding author: L. Stewart Massad, MD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 07 January 2015
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Objective

The objective of the study was to estimate the impact of human immunodeficiency virus (HIV) infection on the incidence of high-grade cervical intraepithelial neoplasia (CIN).

Study Design

HIV-seropositive and comparison seronegative women enrolled in a prospective US cohort study were followed up with semiannual Papanicolaou testing, with colposcopy for any abnormality. Histology results were retrieved to identify CIN3+ (CIN3, adenocarcinoma in situ, and cancer) and CIN2+ (CIN2 and CIN3+). Annual detection rates were calculated and risks compared using a Cox analysis. Median follow-up (interquartile range) was 11.0 (5.4–17.2) years for HIV-seronegative and 9.9 (2.5–16.0) for HIV-seropositive women.

Results

CIN3+ was diagnosed in 139 HIV-seropositive (5%) and 19 HIV-seronegative women (2%) (P < .0001), with CIN2+ in 316 (12%) and 34 (4%) (P < .0001). The annual CIN3+ detection rate was 0.6 per 100 person-years in HIV-seropositive women and 0.2 per 100 person-years in seronegative women (P < .0001). The CIN3+ detection rate fell after the first 2 years of study, from 0.9 per 100 person-years among HIV-seropositive women to 0.4 per 100 person-years during subsequent follow-up (P < .0001). CIN2+ incidence among these women fell similarly with time, from 2.5 per 100 person-years during the first 2 years after enrollment to 0.9 per 100 person-years subsequently (P < .0001). In Cox analyses controlling for age, the hazard ratio for HIV-seropositive women with CD4 counts less than 200/cmm compared with HIV-seronegative women was 8.1 (95% confidence interval, 4.8–13.8) for CIN3+ and 9.3 (95% confidence interval, 6.3–13.7) for CIN2+ (P < .0001).

Conclusion

Although HIV-seropositive women have more CIN3+ than HIV-seronegative women, CIN3+ is uncommon and becomes even less frequent after the initiation of regular cervical screening.

Le texte complet de cet article est disponible en PDF.

Key words : cervical cancer prevention, cervical intraepithelial neoplasia, human immunodeficiency virus in women

Plan

Materials and Methods

Results

Comment

	The views expressed herein are those of the authors and do not necessarily represent the official views of the National Institutes of Health.
	The Women’s Interagency HIV Study is supported by the National Institute of Allergy and Infectious Diseases (grants UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (grant UO1-HD-32632). The study is cosupported by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Support is also provided by the National Center for Research Resources (UCSF-CTSI grant UL1 RR024131). Clinical data and specimens in this manuscript were collected by the Women’s Interagency HIV Study Collaborative Study Group with centers (principal investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); and Data Coordinating Center (Stephen Gange). Additional support, including for statistical analysis, was provided by grant R01 CA85178 (H.D.S.).
	T.M.D. received research supplies for anal cytology, honorarium for webinar on anal cancer screening (2012) from Hologic; stock options from the OncoHealth Advisory Board (ongoing); honorarium paid to UCSF from Roche (2013). A study of H.D.S. involves free blinded testing using HPV E6/E7 protein assays by Arbor Vita (Fremont, CA), p16/Ki67 cytology by MTM Laboratories/Ventura–Roche (Mannheim, Germany), MCM-2/TOP2A cytology from BD Diagnostics (Franklin Lakes, NJ). No financial payments to H.D.S. or his home institution were received. The other authors report no conflict of interest.
	Cite this article as: Massad LS, Xie X, D’Souza G, et al. Incidence of cervical precancers among HIV-seropositive women. Am J Obstet Gynecol 2015;212:xx-xx.