Comorbidities associated with HPV infection among people living with HIV-1 in the southeastern US: a retrospective clinical cohort study

Abstract

Background: The southeastern US is an epicenter for incident HIV in the US with high prevalence of human papillomavirus (HPV) co-infections. However, epidemiologies of HPV-associated clinical conditions (CC) among people living with HIV-1 infection (PLWH) are not fully known. Methods: Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested within the University of Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWH's clinical and sociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical, and vaginal/vulvar low-and high-grade squamous intraepithelial lesions (LSIL and HSIL) were estimated per 10,000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All rates and trends were stratified by gender and race. Results: Of the 4484 PLWH included in the study (3429 men, 1031 women, and 24 transgender), we observed 1038 patients with HPV-related CC. The median nadir CD4 count (cells/uL) was higher in the HPV-condition free group than the case groups (P < 0.0001). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among HIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than black men (P < 0.03). White women were also more likely to be diagnosed with cervical HSIL (P = 0.023) and cancer (P = 0.037) than black women. Conclusions: There were significant differences between gender and race with incidence of HPV-related CC among HIV patients. EMR-based studies provide insights on understudied HPV-related anogenital conditions in PLWH; however, large-scale studies in other regions are needed to generalize current findings and draw public health attention to co-infection induced non-AIDS defining comorbidities among PLWH.

A 12-year retrospective evaluation of anal pre-cancerous lesions and cancer in people living with HIV-1 infection in the Southeastern U.S

“…Our study describes the relevant sociodemographic and clinical characteristics of PLWH diagnosed with anal HSIL and cancer in an urban HIV clinical in the Southeastern U.S. The overall incidence rates of HSIL in our clinical cohort were 338 and 194 per 100,000 person-years among men and women, respectively, with a rate of 258 AC cases per 100,000 men-years (no women presented with AC in the study) during the 12-year follow-up [ 18 ]. By contrast, data from SEER suggest that the incidence of AC in the general US population is 1.6 cases per 100,000 person-years in men and 2.2 cases per 100,000 person-years in women [ 14 ].…”

“…Recent studies among women living with HIV in US have reported the prevalence of anal HSIL to be 27% [ 19 ]. Our previous findings indicated that HIV-infected men had 7.9 times higher risk of incident anal HSIL (432 per 100,000 person-years), compared with HIV-infected women (55 per 100,000 person-years) [ 18 ]. Of note, during this study period, 17 out of 79 patients (21.5%) regressed to low grade squamous cell lesions (LSIL).…”

“…Of note, during this study period, 17 out of 79 patients (21.5%) regressed to low grade squamous cell lesions (LSIL). All 43 AC cases occurred in men; and resulted in an incidence rate of 258 per 100,000 men-years [ 18 ].…”

HSV-infection-related herpetic anogenital ulcer disease among PLWH in southeastern US: electronic medical record based analysis

“…Detailed methods of the Joinpoint regression model were described in a previous study using the same cohort. 21 nadir, median and trajectory CD4 count analysis…”

Rates and Correlates of Incident Type 2 Diabetes Mellitus Among Persons Living With HIV-1 Infection

“…Potential fluctuations in rates over the 18-year follow-up period was assessed by comparing rates among four time intervals (4.5 years each) in two major racial groups (AA and EA). The Joinpoint Trend Analysis software was used to detect possible trends, as described elsewhere (17,18).…”