Silverberg MJ, et al. - In this study, researchers sought to determine the risk of cervical intraepithelial neoplasia grade 2, 2–3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)- and non-HIV-associated immunosuppression. Increased risk of CIN 2 or worse was noted in women with a prior solid organ transplant or who have HIV and CD4+ cells/microliter less than 500. However, it was not observed in women with HIV and higher CD4⁺ levels or in women without a prior solid organ transplant but among those who were prescribed only 1 or 2 immunosuppressive medication classes.

Methods

• A case-control study was performed 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 from 1996 to 2014.
• The researchers 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), risk of CIN 2 or worse was increased compared with those without HIV and in 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.
• Risks were highest 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) than those without HIV and in solid organ transplant recipients prescribed 3 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) compared with women without a prior transplant and zero medication classes.
• The researchers did not observed 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) than 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.