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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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 |
doi_str_mv | 10.1093/jnci/92.18.1500 |
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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 <.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 & 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</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&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 <.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 & 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 & 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 & 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 & 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 & 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 & 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 & Medical Complete (Alumni)</collection><collection>Nursing & 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 <.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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