Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer

Marla J. Keller, Robert D. Burk, L. Stewart Massad, Isam Eldin Eltoum, Nancy A. Hessol, Kathryn Anastos, Xianhong Xie, Howard Minkoff, Xiaonan Xue, Laura L. Reimers, Mark Kuniholm, Gypsyamber DʼSouza, Christine Colie, Bradley Aouizerat, Joel M. Palefsky, Howard D. Strickler

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Recent studies reported a lower human papillomavirus 16 (HPV16) prevalence in cervical precancer among African American than Caucasian women in the general population. We assessed this relationship in women with HIV. DESIGN: Women living with or at risk for HIV in the Women's Interagency HIV Study were followed semi-annually with Pap tests, colposcopy/histology (if indicated), and collection of cervicovaginal lavage samples for HPV testing by PCR. Racial and ethnic groups were defined using genomic Ancestry Informative Markers (AIMs). RESULTS: Among 175 cases of cervical intraepithelial neoplasia 3 or worse (CIN-3+), 154 were diagnosed in women with HIV. African American (27%) and Hispanic (37%) cases were significantly less likely than Caucasian (62%) women to test positive for HPV16 (P = 0.01). In multivariate logistic regression models, these associations remained significant for African Americans (odds ratio = 0.13; 95% confidence interval (CI) 0.04-0.44; P = 0.001) but not Hispanics, after controlling for HIV status, CD4 count, history of AIDS, age, smoking, and sexual behavior. Limiting the analysis to women with HIV did not change the findings. CONCLUSION: HPV16 prevalence is lower in African American compared with Caucasian women with HIV and cervical precancer, independent of immune status. Future studies to determine why these racial differences exist are warranted, and whether there are similar associations between race and invasive cervical cancer in women with HIV. Further, HPV types not covered by quadrivalent and bivalent vaccines may play an especially important role in cervical precancer among HIV-positive African American women, a possible advantage to using nonavalent HPV vaccine in this population.

Original languageEnglish (US)
Pages (from-to)2821-2826
Number of pages6
JournalAIDS (London, England)
Volume32
Issue number18
DOIs
StatePublished - Nov 28 2018

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Papillomaviridae
HIV
African Americans
Human papillomavirus 16
Hispanic Americans
Logistic Models
Papanicolaou Test
Papillomavirus Vaccines
Colposcopy
Cervical Intraepithelial Neoplasia
Therapeutic Irrigation
CD4 Lymphocyte Count
Ethnic Groups

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Keller, M. J., Burk, R. D., Massad, L. S., Eltoum, I. E., Hessol, N. A., Anastos, K., ... Strickler, H. D. (2018). Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer. AIDS (London, England), 32(18), 2821-2826. https://doi.org/10.1097/QAD.0000000000002005

Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer. / Keller, Marla J.; Burk, Robert D.; Massad, L. Stewart; Eltoum, Isam Eldin; Hessol, Nancy A.; Anastos, Kathryn; Xie, Xianhong; Minkoff, Howard; Xue, Xiaonan; Reimers, Laura L.; Kuniholm, Mark; DʼSouza, Gypsyamber; Colie, Christine; Aouizerat, Bradley; Palefsky, Joel M.; Strickler, Howard D.

In: AIDS (London, England), Vol. 32, No. 18, 28.11.2018, p. 2821-2826.

Research output: Contribution to journalArticle

Keller, MJ, Burk, RD, Massad, LS, Eltoum, IE, Hessol, NA, Anastos, K, Xie, X, Minkoff, H, Xue, X, Reimers, LL, Kuniholm, M, DʼSouza, G, Colie, C, Aouizerat, B, Palefsky, JM & Strickler, HD 2018, 'Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer', AIDS (London, England), vol. 32, no. 18, pp. 2821-2826. https://doi.org/10.1097/QAD.0000000000002005
Keller, Marla J. ; Burk, Robert D. ; Massad, L. Stewart ; Eltoum, Isam Eldin ; Hessol, Nancy A. ; Anastos, Kathryn ; Xie, Xianhong ; Minkoff, Howard ; Xue, Xiaonan ; Reimers, Laura L. ; Kuniholm, Mark ; DʼSouza, Gypsyamber ; Colie, Christine ; Aouizerat, Bradley ; Palefsky, Joel M. ; Strickler, Howard D. / Racial differences in human papilloma virus types amongst United States women with HIV and cervical precancer. In: AIDS (London, England). 2018 ; Vol. 32, No. 18. pp. 2821-2826.
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abstract = "OBJECTIVE: Recent studies reported a lower human papillomavirus 16 (HPV16) prevalence in cervical precancer among African American than Caucasian women in the general population. We assessed this relationship in women with HIV. DESIGN: Women living with or at risk for HIV in the Women's Interagency HIV Study were followed semi-annually with Pap tests, colposcopy/histology (if indicated), and collection of cervicovaginal lavage samples for HPV testing by PCR. Racial and ethnic groups were defined using genomic Ancestry Informative Markers (AIMs). RESULTS: Among 175 cases of cervical intraepithelial neoplasia 3 or worse (CIN-3+), 154 were diagnosed in women with HIV. African American (27{\%}) and Hispanic (37{\%}) cases were significantly less likely than Caucasian (62{\%}) women to test positive for HPV16 (P = 0.01). In multivariate logistic regression models, these associations remained significant for African Americans (odds ratio = 0.13; 95{\%} confidence interval (CI) 0.04-0.44; P = 0.001) but not Hispanics, after controlling for HIV status, CD4 count, history of AIDS, age, smoking, and sexual behavior. Limiting the analysis to women with HIV did not change the findings. CONCLUSION: HPV16 prevalence is lower in African American compared with Caucasian women with HIV and cervical precancer, independent of immune status. Future studies to determine why these racial differences exist are warranted, and whether there are similar associations between race and invasive cervical cancer in women with HIV. Further, HPV types not covered by quadrivalent and bivalent vaccines may play an especially important role in cervical precancer among HIV-positive African American women, a possible advantage to using nonavalent HPV vaccine in this population.",
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AU - Keller, Marla J.

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AU - Hessol, Nancy A.

AU - Anastos, Kathryn

AU - Xie, Xianhong

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AU - DʼSouza, Gypsyamber

AU - Colie, Christine

AU - Aouizerat, Bradley

AU - Palefsky, Joel M.

AU - Strickler, Howard D.

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N2 - OBJECTIVE: Recent studies reported a lower human papillomavirus 16 (HPV16) prevalence in cervical precancer among African American than Caucasian women in the general population. We assessed this relationship in women with HIV. DESIGN: Women living with or at risk for HIV in the Women's Interagency HIV Study were followed semi-annually with Pap tests, colposcopy/histology (if indicated), and collection of cervicovaginal lavage samples for HPV testing by PCR. Racial and ethnic groups were defined using genomic Ancestry Informative Markers (AIMs). RESULTS: Among 175 cases of cervical intraepithelial neoplasia 3 or worse (CIN-3+), 154 were diagnosed in women with HIV. African American (27%) and Hispanic (37%) cases were significantly less likely than Caucasian (62%) women to test positive for HPV16 (P = 0.01). In multivariate logistic regression models, these associations remained significant for African Americans (odds ratio = 0.13; 95% confidence interval (CI) 0.04-0.44; P = 0.001) but not Hispanics, after controlling for HIV status, CD4 count, history of AIDS, age, smoking, and sexual behavior. Limiting the analysis to women with HIV did not change the findings. CONCLUSION: HPV16 prevalence is lower in African American compared with Caucasian women with HIV and cervical precancer, independent of immune status. Future studies to determine why these racial differences exist are warranted, and whether there are similar associations between race and invasive cervical cancer in women with HIV. Further, HPV types not covered by quadrivalent and bivalent vaccines may play an especially important role in cervical precancer among HIV-positive African American women, a possible advantage to using nonavalent HPV vaccine in this population.

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