Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome

Background: Human papillomavirus (HPV)-associated anogenital malignancies occur frequently in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). The purpose of our study was to determine if the high frequency of these cancers is due to lifes...

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Veröffentlicht in:JNCI : Journal of the National Cancer Institute 2000-09, Vol.92 (18), p.1500-1510
Hauptverfasser: Frisch, Morten, Biggar, Robert J., Goedert, James J.
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Biggar, Robert J.
Goedert, James J.
description Background: Human papillomavirus (HPV)-associated anogenital malignancies occur frequently in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). The purpose of our study was to determine if the high frequency of these cancers is due to lifestyle factors associated with both HPV and HIV infections or to immunosuppression following HIV infection. Methods: We studied invasive and in situ HPV-associated cancers among 309 365 U.S. patients with HIV infection/AIDS (257 605 males and 51 760 females) from 5 years before the date of AIDS onset to 5 years after this date. Sex-, race-, and age-standardized ratios of observed-to-expected cancers served as measures of relative risk (RR). Trend tests were used to evaluate changes in the RRs during the 10 years spanning AIDS onset. All statistical tests were two-sided. Results: All HPV-associated cancers in AIDS patients occurred in statistically significant excess compared with the expected numbers of cancers. For in situ cancers, overall risks were significantly increased for cervical (RR = 4.6; 95% confidence interval [CI] = 4.3–5.0), vulvar/vaginal (RR = 3.9; 95% CI = 2.0–7.0), anal (in females, RR = 7.8 [95% CI = 0.2–43.6]; in males, RR = 60.1 [95% CI = 49.2–72.7]), and penile (RR = 6.9; 95% CI = 4.2–10.6) cancers, and RRs increased during the 10 years spanning AIDS onset for carcinomas in situ of the cervix (P for trend
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The purpose of our study was to determine if the high frequency of these cancers is due to lifestyle factors associated with both HPV and HIV infections or to immunosuppression following HIV infection. Methods: We studied invasive and in situ HPV-associated cancers among 309 365 U.S. patients with HIV infection/AIDS (257 605 males and 51 760 females) from 5 years before the date of AIDS onset to 5 years after this date. Sex-, race-, and age-standardized ratios of observed-to-expected cancers served as measures of relative risk (RR). Trend tests were used to evaluate changes in the RRs during the 10 years spanning AIDS onset. All statistical tests were two-sided. Results: All HPV-associated cancers in AIDS patients occurred in statistically significant excess compared with the expected numbers of cancers. For in situ cancers, overall risks were significantly increased for cervical (RR = 4.6; 95% confidence interval [CI] = 4.3–5.0), vulvar/vaginal (RR = 3.9; 95% CI = 2.0–7.0), anal (in females, RR = 7.8 [95% CI = 0.2–43.6]; in males, RR = 60.1 [95% CI = 49.2–72.7]), and penile (RR = 6.9; 95% CI = 4.2–10.6) cancers, and RRs increased during the 10 years spanning AIDS onset for carcinomas in situ of the cervix (P for trend &lt;.001), vulva/vagina (P for trend = .04), and penis (P for trend = .04). For invasive cancers, overall risks were significantly increased for cervical (RR = 5.4; 95% CI = 3.9–7.2), vulvar/vaginal (RR = 5.8; 95% CI = 3.0–10.2), and anal (RR = 6.8; 95% CI = 2.7–14.0) cancers in females and for anal (RR = 37.9; 95% CI = 33.0–43.4), penile (RR = 3.7; 95% CI = 2.0–6.2), tonsillar (RR = 2.6; 95% CI = 1.8–3.8), and conjunctival (RR = 14.6; 95% CI = 5.8–30.0) cancers in males. However, RRs for invasive cancers changed little during the 10 years spanning AIDS onset. Conclusions: HPV-associated malignancies occur at increased rates in persons with HIV/AIDS. Increasing RRs for in situ cancers to and beyond the time of AIDS onset may reflect the gradual loss of control over HPV-infected keratinocytes with advancing immunosuppression. However, the lack of a similar increase for invasive HPV-associated cancers suggests that late-stage cancer invasion is not greatly influenced by immune status.</description><identifier>ISSN: 0027-8874</identifier><identifier>ISSN: 1460-2105</identifier><identifier>EISSN: 1460-2105</identifier><identifier>DOI: 10.1093/jnci/92.18.1500</identifier><identifier>PMID: 10995805</identifier><identifier>CODEN: JNCIEQ</identifier><language>eng</language><publisher>Cary, NC: Oxford University Press</publisher><subject>Acquired immune deficiency syndrome ; Adult ; African Americans - statistics &amp; numerical data ; Age Distribution ; Aged ; Aged, 80 and over ; AIDS ; AIDS-Related Opportunistic Infections - complications ; AIDS-Related Opportunistic Infections - virology ; Anus Neoplasms - epidemiology ; Anus Neoplasms - ethnology ; Anus Neoplasms - virology ; Biological and medical sciences ; Cancer ; European Continental Ancestry Group - statistics &amp; numerical data ; Female ; Genital Neoplasms, Female - epidemiology ; Genital Neoplasms, Female - ethnology ; Genital Neoplasms, Female - virology ; Hispanic Americans - statistics &amp; numerical data ; HIV ; Human immunodeficiency virus ; Human papillomavirus ; Human viral diseases ; Humans ; Infectious diseases ; Male ; Medical sciences ; Middle Aged ; Papillomaviridae ; Papillomavirus Infections - complications ; Papillomavirus Infections - virology ; Penile Neoplasms - epidemiology ; Penile Neoplasms - ethnology ; Penile Neoplasms - virology ; Registries ; Risk ; Sexually transmitted diseases ; STD ; Tumor Virus Infections - complications ; Tumor Virus Infections - virology ; United States - epidemiology ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>JNCI : Journal of the National Cancer Institute, 2000-09, Vol.92 (18), p.1500-1510</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright Superintendent of Documents Sep 20, 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-a80a265caa7afded64c8092e63bfdbd20b40697417489c69305d2859eb033c153</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=814715$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10995805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frisch, Morten</creatorcontrib><creatorcontrib>Biggar, Robert J.</creatorcontrib><creatorcontrib>Goedert, James J.</creatorcontrib><title>Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome</title><title>JNCI : Journal of the National Cancer Institute</title><addtitle>JNCI J Natl Cancer Inst</addtitle><description>Background: Human papillomavirus (HPV)-associated anogenital malignancies occur frequently in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). The purpose of our study was to determine if the high frequency of these cancers is due to lifestyle factors associated with both HPV and HIV infections or to immunosuppression following HIV infection. Methods: We studied invasive and in situ HPV-associated cancers among 309 365 U.S. patients with HIV infection/AIDS (257 605 males and 51 760 females) from 5 years before the date of AIDS onset to 5 years after this date. Sex-, race-, and age-standardized ratios of observed-to-expected cancers served as measures of relative risk (RR). Trend tests were used to evaluate changes in the RRs during the 10 years spanning AIDS onset. All statistical tests were two-sided. Results: All HPV-associated cancers in AIDS patients occurred in statistically significant excess compared with the expected numbers of cancers. For in situ cancers, overall risks were significantly increased for cervical (RR = 4.6; 95% confidence interval [CI] = 4.3–5.0), vulvar/vaginal (RR = 3.9; 95% CI = 2.0–7.0), anal (in females, RR = 7.8 [95% CI = 0.2–43.6]; in males, RR = 60.1 [95% CI = 49.2–72.7]), and penile (RR = 6.9; 95% CI = 4.2–10.6) cancers, and RRs increased during the 10 years spanning AIDS onset for carcinomas in situ of the cervix (P for trend &lt;.001), vulva/vagina (P for trend = .04), and penis (P for trend = .04). For invasive cancers, overall risks were significantly increased for cervical (RR = 5.4; 95% CI = 3.9–7.2), vulvar/vaginal (RR = 5.8; 95% CI = 3.0–10.2), and anal (RR = 6.8; 95% CI = 2.7–14.0) cancers in females and for anal (RR = 37.9; 95% CI = 33.0–43.4), penile (RR = 3.7; 95% CI = 2.0–6.2), tonsillar (RR = 2.6; 95% CI = 1.8–3.8), and conjunctival (RR = 14.6; 95% CI = 5.8–30.0) cancers in males. However, RRs for invasive cancers changed little during the 10 years spanning AIDS onset. Conclusions: HPV-associated malignancies occur at increased rates in persons with HIV/AIDS. Increasing RRs for in situ cancers to and beyond the time of AIDS onset may reflect the gradual loss of control over HPV-infected keratinocytes with advancing immunosuppression. However, the lack of a similar increase for invasive HPV-associated cancers suggests that late-stage cancer invasion is not greatly influenced by immune status.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>African Americans - statistics &amp; numerical data</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>AIDS</subject><subject>AIDS-Related Opportunistic Infections - complications</subject><subject>AIDS-Related Opportunistic Infections - virology</subject><subject>Anus Neoplasms - epidemiology</subject><subject>Anus Neoplasms - ethnology</subject><subject>Anus Neoplasms - virology</subject><subject>Biological and medical sciences</subject><subject>Cancer</subject><subject>European Continental Ancestry Group - statistics &amp; numerical data</subject><subject>Female</subject><subject>Genital Neoplasms, Female - epidemiology</subject><subject>Genital Neoplasms, Female - ethnology</subject><subject>Genital Neoplasms, Female - virology</subject><subject>Hispanic Americans - statistics &amp; numerical data</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Human papillomavirus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Papillomaviridae</subject><subject>Papillomavirus Infections - complications</subject><subject>Papillomavirus Infections - virology</subject><subject>Penile Neoplasms - epidemiology</subject><subject>Penile Neoplasms - ethnology</subject><subject>Penile Neoplasms - virology</subject><subject>Registries</subject><subject>Risk</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Tumor Virus Infections - complications</subject><subject>Tumor Virus Infections - virology</subject><subject>United States - epidemiology</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>0027-8874</issn><issn>1460-2105</issn><issn>1460-2105</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0U1r2zAYB3AxVta023m3YTbozYkkW2_HELomkNFB9xJ2EbIkM2W2nEp2ab7APvfkOZSxHaaLDvo9f3j0B-A1gnMERbHYe-0WAs8RnyMC4TMwQyWFOUaQPAczCDHLOWflObiIcQ_TEbh8Ac7TrCAckhn4uR5a5bOP6uCapmvVgwtDzJcxdtqp3ppspby2IWZuRL2zvo_ZV9d_z6bBTdsOvjO2djq96WP2ZQzINr62unedz5Q32VLfDy6ksH_03dGb0LX2JTirVRPtq9N9CT6_v_60Wufb25vNarnNdUl4nysOFaZEK8VUbayhpeZpJUuLqjaVwbAqIRWsRKzkQlNRQGIwJ8JWsCg0IsUluJpyD6G7H2zsZeuitk2jvO2GKBlOnJLivxAxmiijCb79C-67Ifi0hMQYivT5QiS0mJAOXYzB1vIQXKvCUSIoxyLlWKQUWCIuxyLTxJtT7FC11vzhp-YSeHcCKmrV1CH15OKT46hkv_fNJ-Vibx-fXlX4ISkrGJHr3TeJ7j7Q3c1uK3fFLwtot0c</recordid><startdate>20000920</startdate><enddate>20000920</enddate><creator>Frisch, Morten</creator><creator>Biggar, Robert J.</creator><creator>Goedert, James J.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20000920</creationdate><title>Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome</title><author>Frisch, Morten ; Biggar, Robert J. ; Goedert, James J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-a80a265caa7afded64c8092e63bfdbd20b40697417489c69305d2859eb033c153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adult</topic><topic>African Americans - statistics &amp; numerical data</topic><topic>Age Distribution</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>AIDS</topic><topic>AIDS-Related Opportunistic Infections - complications</topic><topic>AIDS-Related Opportunistic Infections - virology</topic><topic>Anus Neoplasms - epidemiology</topic><topic>Anus Neoplasms - ethnology</topic><topic>Anus Neoplasms - virology</topic><topic>Biological and medical sciences</topic><topic>Cancer</topic><topic>European Continental Ancestry Group - statistics &amp; numerical data</topic><topic>Female</topic><topic>Genital Neoplasms, Female - epidemiology</topic><topic>Genital Neoplasms, Female - ethnology</topic><topic>Genital Neoplasms, Female - virology</topic><topic>Hispanic Americans - statistics &amp; numerical data</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Human papillomavirus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Papillomaviridae</topic><topic>Papillomavirus Infections - complications</topic><topic>Papillomavirus Infections - virology</topic><topic>Penile Neoplasms - epidemiology</topic><topic>Penile Neoplasms - ethnology</topic><topic>Penile Neoplasms - virology</topic><topic>Registries</topic><topic>Risk</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><topic>Tumor Virus Infections - complications</topic><topic>Tumor Virus Infections - virology</topic><topic>United States - epidemiology</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frisch, Morten</creatorcontrib><creatorcontrib>Biggar, Robert J.</creatorcontrib><creatorcontrib>Goedert, James J.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>JNCI : Journal of the National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frisch, Morten</au><au>Biggar, Robert J.</au><au>Goedert, James J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome</atitle><jtitle>JNCI : Journal of the National Cancer Institute</jtitle><addtitle>JNCI J Natl Cancer Inst</addtitle><date>2000-09-20</date><risdate>2000</risdate><volume>92</volume><issue>18</issue><spage>1500</spage><epage>1510</epage><pages>1500-1510</pages><issn>0027-8874</issn><issn>1460-2105</issn><eissn>1460-2105</eissn><coden>JNCIEQ</coden><abstract>Background: Human papillomavirus (HPV)-associated anogenital malignancies occur frequently in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). The purpose of our study was to determine if the high frequency of these cancers is due to lifestyle factors associated with both HPV and HIV infections or to immunosuppression following HIV infection. Methods: We studied invasive and in situ HPV-associated cancers among 309 365 U.S. patients with HIV infection/AIDS (257 605 males and 51 760 females) from 5 years before the date of AIDS onset to 5 years after this date. Sex-, race-, and age-standardized ratios of observed-to-expected cancers served as measures of relative risk (RR). Trend tests were used to evaluate changes in the RRs during the 10 years spanning AIDS onset. All statistical tests were two-sided. Results: All HPV-associated cancers in AIDS patients occurred in statistically significant excess compared with the expected numbers of cancers. For in situ cancers, overall risks were significantly increased for cervical (RR = 4.6; 95% confidence interval [CI] = 4.3–5.0), vulvar/vaginal (RR = 3.9; 95% CI = 2.0–7.0), anal (in females, RR = 7.8 [95% CI = 0.2–43.6]; in males, RR = 60.1 [95% CI = 49.2–72.7]), and penile (RR = 6.9; 95% CI = 4.2–10.6) cancers, and RRs increased during the 10 years spanning AIDS onset for carcinomas in situ of the cervix (P for trend &lt;.001), vulva/vagina (P for trend = .04), and penis (P for trend = .04). For invasive cancers, overall risks were significantly increased for cervical (RR = 5.4; 95% CI = 3.9–7.2), vulvar/vaginal (RR = 5.8; 95% CI = 3.0–10.2), and anal (RR = 6.8; 95% CI = 2.7–14.0) cancers in females and for anal (RR = 37.9; 95% CI = 33.0–43.4), penile (RR = 3.7; 95% CI = 2.0–6.2), tonsillar (RR = 2.6; 95% CI = 1.8–3.8), and conjunctival (RR = 14.6; 95% CI = 5.8–30.0) cancers in males. However, RRs for invasive cancers changed little during the 10 years spanning AIDS onset. Conclusions: HPV-associated malignancies occur at increased rates in persons with HIV/AIDS. Increasing RRs for in situ cancers to and beyond the time of AIDS onset may reflect the gradual loss of control over HPV-infected keratinocytes with advancing immunosuppression. However, the lack of a similar increase for invasive HPV-associated cancers suggests that late-stage cancer invasion is not greatly influenced by immune status.</abstract><cop>Cary, NC</cop><pub>Oxford University Press</pub><pmid>10995805</pmid><doi>10.1093/jnci/92.18.1500</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects Acquired immune deficiency syndrome
Adult
African Americans - statistics & numerical data
Age Distribution
Aged
Aged, 80 and over
AIDS
AIDS-Related Opportunistic Infections - complications
AIDS-Related Opportunistic Infections - virology
Anus Neoplasms - epidemiology
Anus Neoplasms - ethnology
Anus Neoplasms - virology
Biological and medical sciences
Cancer
European Continental Ancestry Group - statistics & numerical data
Female
Genital Neoplasms, Female - epidemiology
Genital Neoplasms, Female - ethnology
Genital Neoplasms, Female - virology
Hispanic Americans - statistics & numerical data
HIV
Human immunodeficiency virus
Human papillomavirus
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Papillomaviridae
Papillomavirus Infections - complications
Papillomavirus Infections - virology
Penile Neoplasms - epidemiology
Penile Neoplasms - ethnology
Penile Neoplasms - virology
Registries
Risk
Sexually transmitted diseases
STD
Tumor Virus Infections - complications
Tumor Virus Infections - virology
United States - epidemiology
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
title Human Papillomavirus-Associated Cancers in Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome
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