@article{TEXTUAL,
      recid = {10818},
      author = {Anastos, Kathryn and Hoover, Donald R. and Burk, Robert D.  and Cajigas, Antonio and Shi, Qiuhu and Singh, Diljeet K.  and Cohen, Mardge H. and Mutimura, Eugene and Sturgis,  Charles and Banzhaf, William C. and Castle, Philip E.},
      title = {Risk Factors for Cervical Precancer and Cancer in  HIV-Infected, HPV-Positive Rwandan Women},
      journal = {PLOS ONE},
      address = {2010-10-20},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Background: Although cervical cancer is an  AIDS-defining condition, infection with human  immunodeficiency virus (HIV) may only modestly increase the  risk of cervical cancer. There is a paucity of information  regarding factors that influence the natural history of  human papillomavirus (HPV) in HIV-infected women. We  examined factors associated with cervical intraepithelial  neoplasia grade 3 or cancer (CIN3+) in Rwandan women  infected with both HIV and HPV (HIV+/HPV+).&lt;/p&gt;&lt;p&gt;Methods:  In 2005, 710 HIV+ Rwandan women ≥25 years enrolled in an  observational cohort study; 476 (67%) tested HPV+. Each  woman provided sociodemographic data, CD4 count, a cervical  cytology specimen and cervicovaginal lavage (CVL), which  was tested for &gt;40 HPV genotypes by MY09/MY11 PCR assay.  Logistic regression models calculated odds ratios (OR) and  95% confidence intervals (CI) of associations of potential  risk factors for CIN3+ among HIV+/HPV+  women.&lt;/p&gt;&lt;p&gt;Results: Of the 476 HIV+/HPV+ women 42 (8.8%)  were diagnosed with CIN3+. Factors associated with CIN3+  included ≥7 (vs. 0-2) pregnancies, malarial infection in  the previous six months (vs. never), and ≥7 (vs. 0-2)  lifetime sexual partners. Compared to women infected by  non-HPV16 carcinogenic HPV genotypes, HPV16 infection was  positively associated and non-carcinogenic HPV infection  was inversely associated with CIN3+. CD4 count was  significantly associated with CIN3+ only in analyses of  women with non-HPV16 carcinogenic HPV (OR = 0.62 per 100  cells/mm&lt;sup&gt;3&lt;/sup&gt;, CI = 0.40-0.97).&lt;/p&gt;&lt;p&gt;Conclusions:  In this HIV+/HPV+ population, lower CD4 was significantly  associated with CIN3+ only in women infected with  carcinogenic non-HPV16. We found a trend for higher risk of  CIN3+ in HIV+ women reporting recent malarial infection;  this association should be investigated in a larger group  of HIV+/HPV+ women.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/10818},
}