Immunodeficiency and the risk of cervical intra-epithelial neoplasia 2/3 and cervical cancer: A nested case-control study in the Swiss HIV Cohort Study.

Clifford, Gary M; Franceschi, Silvia; Keiser, Olivia; Schöni-Affolter, Franziska; Lise, Mauro; Dehler, Silvia; Levi, Fabio; Mousavi, Mohsen; Bouchardy, Christine; Wolfensberger, Aline; Darling, Katharine E; Stähelin, Cornelia Johanna; Bertisch, Barbara; Kuenzli, Esther; Bernasconi, Enos; Pawlita, Michael; Egger, Matthias (2016). Immunodeficiency and the risk of cervical intra-epithelial neoplasia 2/3 and cervical cancer: A nested case-control study in the Swiss HIV Cohort Study. International journal of cancer, 138(7), pp. 1732-40. Wiley-Blackwell 10.1002/ijc.29913

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HIV-infected women are at increased risk of cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer (ICC), but it has been difficult to disentangle the influences of heavy exposure to HPV infection, inadequate screening, and immunodeficiency. A case-control study including 364 CIN2/3 and 20 ICC cases matched to 1,147 controls was nested in the Swiss HIV Cohort Study (1985-2013). CIN2/3 risk was significantly associated with low CD4+ cell counts, whether measured as nadir (odds ratio (OR) per 100-cell/μL decrease=1.15, 95% CI: 1.08, 1.22), or at CIN2/3 diagnosis (1.10, 95% CI: 1.04, 1.16). An association was evident even for nadir CD4+ 200-349 versus ≥350 cells/μL (OR=1.57, 95% CI: 1.09, 2.25). After adjustment for nadir CD4+, a protective effect of >2-year cART use was seen against CIN2/3 (OR versus never cART use=0.64, 95% CI: 0.42, 0.98). Despite low study power, similar associations were seen for ICC, notably with nadir CD4+ (OR for 50 versus >350 cells/μL= 11.10, 95% CI: 1.24, 100). HPV16-L1 antibodies were significantly associated with CIN2/3, but HPV16-E6 antibodies were nearly exclusively detected in ICC. In conclusion, worsening immunodeficiency, even at only moderately decreased CD4+ cell counts (200-349 CD4+ cells/μL), is a significant risk factor for CIN2/3 and cervical cancer. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Keiser, Olivia; Schöni-Affolter, Franziska; Stähelin, Cornelia Johanna; Bertisch, Barbara and Egger, Matthias

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0020-7136

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

19 Nov 2015 11:42

Last Modified:

19 Sep 2017 13:56

Publisher DOI:

10.1002/ijc.29913

PubMed ID:

26537763

Uncontrolled Keywords:

HIV; cervical cancer; cervical neoplasia; human papillomavirus; immunodeficiency

BORIS DOI:

10.7892/boris.73017

URI:

https://boris.unibe.ch/id/eprint/73017

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