American Journal of Epidemiology Advance Access published online on June 14, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj165
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1 Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
* To whom correspondence should be addressed. Persistent human papillomavirus (HPV) infection seems central to cervical carcinogenesis. Smoking is associated with cervical cancer in HPV DNA-positive women, but its association with HPV persistence is unclear, particularly with respect to human immunodeficiency virus (HIV) serostatus. The authors evaluated smoking and HPV clearance by HIV serostatus among 801 women from the HIV Epidemiology Research Study (United States, 1993-2000). Type-specific HPV duration was defined as the interval between initial MY09/11 polymerase chain reaction positivity and the first of two consecutive HPV-negative study visits. Hazard ratios adjusted for study site and risk behaviors (sexual activity or injection drug use) were estimated using Cox regression. This analysis included 522 HIV-seropositive and 279 HIV-seronegative women (median follow-up, 4.4 years). Ever smoking was associated with reduced clearance of high-risk HPV in HIV-seronegative women (hazard ratio (HR) = 0.51, 95% confidence interval (CI): 0.30, 0.88) but not in HIV-seropositive women (HR = 0.96, 95% CI: 0.65, 1.42); similar results were found for current smoking. Current smoking was not associated with clearance of any type-specific HPV in HIV-seropositive (HR = 0.99, 95% CI: 0.82, 1.20) or HIV-seronegative (HR = 0.93, 95% CI: 0.68, 1.26) women. HPV clearance did not appear to vary by amount or duration of smoking. Smoking did not modify overall clearance but was associated with lower high-risk HPV clearance in HIV-seronegative women.
Received August 16, 2005
Accepted January 20, 2006
ORIGINAL CONTRIBUTIONS
Smoking and Time to Clearance of Human Papillomavirus Infection in HIV-Seropositive and HIV-Seronegative Women
Jill Koshiol 1 *,
Jane Schroeder 1,
Denise J. Jamieson 2,
Stephen W. Marshall 1,
Ann Duerr 3,
Charles M. Heilig 4,
Keerti V. Shah 5,
Robert S. Klein 6,
Susan Cu-Uvin 7,
Paula Schuman 8,
David Celentano 9,
and
Jennifer S. Smith 1
2 Division of Reproductive Health, Women's Health and Fertility Branch, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
3 HIV Vaccine Trials Network, Seattle, WA
4 Office of the Chief Science Officer, Centers for Disease Control and Prevention, Atlanta, GA
5 Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
6 Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
7 Department of Obstetrics and Gynecology, Brown Medical School, Brown University, Providence, RI
8 Department of Infectious Disease and Quality Health Care, School of Medicine, Virginia Commonwealth University, Richmond, VA; Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI
9 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Jill Koshiol, E-mail: koshiolj{at}mail.nih.gov
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