Human Immunodeficiency Virus (HIV) and Non-HIV–Associated Immunosuppression and Risk of Cervical Neoplasia
| Autor: | Michael J. Silverberg, Steven E. Gregorich, Megan J. Huchko, Anna Seto, Aileen Chi, Wendy A. Leyden, Shalini L Kulasingam, Miriam Kuppermann, George F. Sawaya, Karen Smith-McCune |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_treatment
Human immunodeficiency virus (HIV) Uterine Cervical Neoplasms HIV Infections medicine.disease_cause California 0302 clinical medicine Reference Values Medicine 030212 general & internal medicine Registries Incidence (epidemiology) Incidence Obstetrics and Gynecology Immunosuppression Middle Aged Prognosis Infectious Diseases 030220 oncology & carcinogenesis HIV/AIDS Female Infection Risk assessment Adult medicine.medical_specialty Clinical Trials and Supportive Activities Adenocarcinoma Risk Assessment Article Paediatrics and Reproductive Medicine 03 medical and health sciences Age Distribution Clinical Research Cervical intraepithelial neoplasia grade 2 Internal medicine Humans Neoplasm Invasiveness Obstetrics & Reproductive Medicine Neoplasm Staging Immunosuppression Therapy Transplantation business.industry Prevention Case-control study Cancer Organ Transplantation medicine.disease Uterine Cervical Dysplasia Logistic Models Case-Control Studies business Solid organ transplantation |
| Zdroj: | Silverberg, MJ; Leyden, WA; Chi, A; Gregorich, S; Huchko, MJ; Kulasingam, S; et al.(2018). Human Immunodeficiency Virus (HIV)-and Non-HIV-Associated Immunosuppression and Risk of Cervical Neoplasia. OBSTETRICS AND GYNECOLOGY, 131(1), 47-55. doi: 10.1097/AOG.0000000000002371. UC San Francisco: Retrieved from: http://www.escholarship.org/uc/item/03j8q7wm Obstetrics and gynecology, vol 131, iss 1 |
| DOI: | 10.1097/AOG.0000000000002371. |
| Popis: | Author(s): Silverberg, Michael J; Leyden, Wendy A; Chi, Aileen; Gregorich, Steven; Huchko, Megan J; Kulasingam, Shalini; Kuppermann, Miriam; Seto, Anna; Smith-McCune, Karen K; Sawaya, George F | 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. |
| Databáze: | OpenAIRE |
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