Silverberg MJ, et al. - Among women with human immunodeficiency virus (HIV)– and non-HIV–associated immunosuppression, the authors determined the risk of cervical intraepithelial neoplasia grade 2, 2–3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse). Observations revealed an increased risk of CIN 2 or worse in women with a prior solid organ transplant or who have HIV and CD4+ cells/microliter less than 500, however, this was not observed in women with HIV and higher CD4+ levels or in women without a prior solid organ transplant but who are prescribed only one or two immunosuppressive medication classes.

Methods

• From 1996 to 2014, researchers undertook a case–control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n=100,144) enrolled in an integrated health care system.
• They obtained adjusted rate ratios (RRs) from conditional logistic regression for HIV status (stratified by CD4+ T-cells), solid organ transplant history, and immunosuppressive medication use.

Results

• Among women with HIV (n=36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3–3.0), increased risk of CIN 2 or worse was observed in comparison to those without HIV; the increased risk was also observed among solid organ transplant recipients (n=51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3–4.8) compared with women without a prior transplant.
• Researchers noticed the highest risks among women with HIV and less than 200 CD4+ T-cells/microliter (n=9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1–14.7) compared with those without HIV; compared with women without a prior transplant and zero medication classes, the highest risks were noticed in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n=32 women in the case group and 33 women in the control group; RR 4.1, 95% CI 2.5–6.8).
• Observations revealed no increased risks for women with HIV and 500 or greater CD4+ T-cells/microliter (n=9 women in the case group and 43 women in the control group; RR 0.8, 95% CI 0.4–1.7) compared with those without HIV or women without prior solid organ transplantation prescribed two or fewer immunosuppressive medication classes (n=1,262 women in the case group and 6,100 women in the control group; RR 0.95, 95% CI 0.89–1.01) compared with women without and a prior transplant and zero medication classes.