The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women

Howard Minkoff, Ye Zhong, Howard D. Strickler, D. Heather Watts, Joel M. Palefsky, Alexandra M. Levine, Gypsyamber D'Souza, Andrea A. Howard, Michael Plankey, L. Stewart Massad, Robert Burk

Research output: Contribution to journalArticle

Abstract

Objective. Animal data suggest that cocaine has an immunosuppressive effect, but no human studies have been conducted to assess the relation of cocaine use with human papillomavirus (HPV) infection, the viral cause of cervical cancer. Since both cocaine use and HPV infection are common among HIV-positive women, we sought to determine whether use of cocaine and/or crack influences the natural history of HPV among women with or at high risk of HIV. Methods. Women enrolled in the Women's Interagency HIV Study (2278 HIV-seropositive and 826 high-risk seronegative women) were examined every six months for up to 9.5 years with Pap smear, collection of cervicovaginal lavage (CVL) samples, and detailed questionnaires regarding health and behavior, including use of crack and cocaine (crack/cocaine). CVLs were tested for HPV DNA by PCR, with genotyping for over forty HPV types. Results. In multivariate logistic regression models, censoring women treated for cervical neoplasia, crack/cocaine use within the last six months was associated with prevalent detection of oncogenic HPV DNA (odds ratio [OR] = 1.30 (1.09-1.55)), and with oncogenic HPV-positive squamous intraepithelial lesions (SIL) (OR = 1.70 (1.27-2.27)), following adjustment for age, race, HIV-serostatus, and CD4+ T-cell count, the number of sexual partners in the past six months, and smoking. In multivariate Cox models crack/cocaine use was also associated with a trend that approached significance in regard to incident detection of oncogenic HPV-positive SIL (HR = 1.51, 95% CI 0.99-2.30), and while the rate of oncogenic HPV clearance was not related to cocaine use, the clearance of any SIL was significantly lower in those with versus those without recent crack/cocaine use (HR = 0.57, 95% CI 0.34-0.97). Conclusions. Cocaine use is associated with an increased risk of detection of both prevalent and incident oncogenic HPV infection, as well as an increased risk of HPV-positive SIL over time.

Original languageEnglish (US)
Article number587082
JournalInfectious Diseases in Obstetrics and Gynecology
Volume2008
DOIs
StatePublished - 2008

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Papillomavirus Infections
Cocaine
HIV
Crack Cocaine
Logistic Models
Odds Ratio
Papanicolaou Test
Sexual Partners
Therapeutic Irrigation
DNA
Health Behavior
Immunosuppressive Agents
CD4 Lymphocyte Count
Natural History
Proportional Hazards Models
Uterine Cervical Neoplasms
Cell Count
Smoking

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Dermatology

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The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women. / Minkoff, Howard; Zhong, Ye; Strickler, Howard D.; Watts, D. Heather; Palefsky, Joel M.; Levine, Alexandra M.; D'Souza, Gypsyamber; Howard, Andrea A.; Plankey, Michael; Massad, L. Stewart; Burk, Robert.

In: Infectious Diseases in Obstetrics and Gynecology, Vol. 2008, 587082, 2008.

Research output: Contribution to journalArticle

Minkoff, H, Zhong, Y, Strickler, HD, Watts, DH, Palefsky, JM, Levine, AM, D'Souza, G, Howard, AA, Plankey, M, Massad, LS & Burk, R 2008, 'The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women', Infectious Diseases in Obstetrics and Gynecology, vol. 2008, 587082. https://doi.org/10.1155/2008/587082
Minkoff, Howard ; Zhong, Ye ; Strickler, Howard D. ; Watts, D. Heather ; Palefsky, Joel M. ; Levine, Alexandra M. ; D'Souza, Gypsyamber ; Howard, Andrea A. ; Plankey, Michael ; Massad, L. Stewart ; Burk, Robert. / The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women. In: Infectious Diseases in Obstetrics and Gynecology. 2008 ; Vol. 2008.
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abstract = "Objective. Animal data suggest that cocaine has an immunosuppressive effect, but no human studies have been conducted to assess the relation of cocaine use with human papillomavirus (HPV) infection, the viral cause of cervical cancer. Since both cocaine use and HPV infection are common among HIV-positive women, we sought to determine whether use of cocaine and/or crack influences the natural history of HPV among women with or at high risk of HIV. Methods. Women enrolled in the Women's Interagency HIV Study (2278 HIV-seropositive and 826 high-risk seronegative women) were examined every six months for up to 9.5 years with Pap smear, collection of cervicovaginal lavage (CVL) samples, and detailed questionnaires regarding health and behavior, including use of crack and cocaine (crack/cocaine). CVLs were tested for HPV DNA by PCR, with genotyping for over forty HPV types. Results. In multivariate logistic regression models, censoring women treated for cervical neoplasia, crack/cocaine use within the last six months was associated with prevalent detection of oncogenic HPV DNA (odds ratio [OR] = 1.30 (1.09-1.55)), and with oncogenic HPV-positive squamous intraepithelial lesions (SIL) (OR = 1.70 (1.27-2.27)), following adjustment for age, race, HIV-serostatus, and CD4+ T-cell count, the number of sexual partners in the past six months, and smoking. In multivariate Cox models crack/cocaine use was also associated with a trend that approached significance in regard to incident detection of oncogenic HPV-positive SIL (HR = 1.51, 95{\%} CI 0.99-2.30), and while the rate of oncogenic HPV clearance was not related to cocaine use, the clearance of any SIL was significantly lower in those with versus those without recent crack/cocaine use (HR = 0.57, 95{\%} CI 0.34-0.97). Conclusions. Cocaine use is associated with an increased risk of detection of both prevalent and incident oncogenic HPV infection, as well as an increased risk of HPV-positive SIL over time.",
author = "Howard Minkoff and Ye Zhong and Strickler, {Howard D.} and Watts, {D. Heather} and Palefsky, {Joel M.} and Levine, {Alexandra M.} and Gypsyamber D'Souza and Howard, {Andrea A.} and Michael Plankey and Massad, {L. Stewart} and Robert Burk",
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T1 - The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women

AU - Minkoff, Howard

AU - Zhong, Ye

AU - Strickler, Howard D.

AU - Watts, D. Heather

AU - Palefsky, Joel M.

AU - Levine, Alexandra M.

AU - D'Souza, Gypsyamber

AU - Howard, Andrea A.

AU - Plankey, Michael

AU - Massad, L. Stewart

AU - Burk, Robert

PY - 2008

Y1 - 2008

N2 - Objective. Animal data suggest that cocaine has an immunosuppressive effect, but no human studies have been conducted to assess the relation of cocaine use with human papillomavirus (HPV) infection, the viral cause of cervical cancer. Since both cocaine use and HPV infection are common among HIV-positive women, we sought to determine whether use of cocaine and/or crack influences the natural history of HPV among women with or at high risk of HIV. Methods. Women enrolled in the Women's Interagency HIV Study (2278 HIV-seropositive and 826 high-risk seronegative women) were examined every six months for up to 9.5 years with Pap smear, collection of cervicovaginal lavage (CVL) samples, and detailed questionnaires regarding health and behavior, including use of crack and cocaine (crack/cocaine). CVLs were tested for HPV DNA by PCR, with genotyping for over forty HPV types. Results. In multivariate logistic regression models, censoring women treated for cervical neoplasia, crack/cocaine use within the last six months was associated with prevalent detection of oncogenic HPV DNA (odds ratio [OR] = 1.30 (1.09-1.55)), and with oncogenic HPV-positive squamous intraepithelial lesions (SIL) (OR = 1.70 (1.27-2.27)), following adjustment for age, race, HIV-serostatus, and CD4+ T-cell count, the number of sexual partners in the past six months, and smoking. In multivariate Cox models crack/cocaine use was also associated with a trend that approached significance in regard to incident detection of oncogenic HPV-positive SIL (HR = 1.51, 95% CI 0.99-2.30), and while the rate of oncogenic HPV clearance was not related to cocaine use, the clearance of any SIL was significantly lower in those with versus those without recent crack/cocaine use (HR = 0.57, 95% CI 0.34-0.97). Conclusions. Cocaine use is associated with an increased risk of detection of both prevalent and incident oncogenic HPV infection, as well as an increased risk of HPV-positive SIL over time.

AB - Objective. Animal data suggest that cocaine has an immunosuppressive effect, but no human studies have been conducted to assess the relation of cocaine use with human papillomavirus (HPV) infection, the viral cause of cervical cancer. Since both cocaine use and HPV infection are common among HIV-positive women, we sought to determine whether use of cocaine and/or crack influences the natural history of HPV among women with or at high risk of HIV. Methods. Women enrolled in the Women's Interagency HIV Study (2278 HIV-seropositive and 826 high-risk seronegative women) were examined every six months for up to 9.5 years with Pap smear, collection of cervicovaginal lavage (CVL) samples, and detailed questionnaires regarding health and behavior, including use of crack and cocaine (crack/cocaine). CVLs were tested for HPV DNA by PCR, with genotyping for over forty HPV types. Results. In multivariate logistic regression models, censoring women treated for cervical neoplasia, crack/cocaine use within the last six months was associated with prevalent detection of oncogenic HPV DNA (odds ratio [OR] = 1.30 (1.09-1.55)), and with oncogenic HPV-positive squamous intraepithelial lesions (SIL) (OR = 1.70 (1.27-2.27)), following adjustment for age, race, HIV-serostatus, and CD4+ T-cell count, the number of sexual partners in the past six months, and smoking. In multivariate Cox models crack/cocaine use was also associated with a trend that approached significance in regard to incident detection of oncogenic HPV-positive SIL (HR = 1.51, 95% CI 0.99-2.30), and while the rate of oncogenic HPV clearance was not related to cocaine use, the clearance of any SIL was significantly lower in those with versus those without recent crack/cocaine use (HR = 0.57, 95% CI 0.34-0.97). Conclusions. Cocaine use is associated with an increased risk of detection of both prevalent and incident oncogenic HPV infection, as well as an increased risk of HPV-positive SIL over time.

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