Human Immunodeficiency Virus (HIV)– and Non-HIV–Associated Immunosuppression and Risk of Cervical Neoplasia

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Abstract

OBJECTIVE:

To estimate the risk of cervical intraepithelial neoplasia grade 2, 2–3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)– and non-HIV–associated immunosuppression.

METHODS:

We performed a case–control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n=100,144) enrolled in an integrated health care system from 1996 to 2014. Adjusted rate ratios (RRs) from conditional logistic regression were obtained for HIV status (stratified by CD4+ T-cells), solid organ transplant history, and immunosuppressive medication use.

RESULTS:

Risk of CIN 2 or worse was increased among women with HIV (n=36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3–3.0) compared with those without HIV and in solid organ transplant recipients (n=51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3–4.8) compared with women without a prior transplant. The highest risks were among women with HIV and less than 200 CD4+ T-cells/microliter (n=9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1–14.7) compared with those without HIV and in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n=32 women in the case group and 33 women in the control group; RR 4.1, 95% CI 2.5–6.8) compared with women without a prior transplant and zero medication classes. No increased risks were observed for women with HIV and 500 or greater CD4+ T-cells/microliter (n=9 women in the case group and 43 women in the control group; RR 0.8, 95% CI 0.4–1.7) compared with those without HIV or women without prior solid organ transplantation prescribed two or fewer immunosuppressive medication classes (n=1,262 women in the case group and 6,100 women in the control group; RR 0.95, 95% CI 0.89–1.01) compared with women without and a prior transplant and zero medication classes.

CONCLUSION:

Risk of CIN 2 or worse is increased in women with a prior solid organ transplant or who have HIV and CD4+ cells/microliter less than 500 but not in women with HIV and higher CD4+ levels or in women without a prior solid organ transplant but who are prescribed only one or two immunosuppressive medication classes.

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