Smoking increases papillomavirus risk in HIV-infected women

Main Category: HIV / AIDS
Article Date: 30 Apr 2004 - 0:00 PDT

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Women with HIV infection who smoke are more likely than women not infected with HIV to acquire and have prevalent human papillomavirus (HPV) infection, according to a study published in the May 1 issue of The Journal of Infectious Diseases, now available online.

Given the clear link between persistent infection with certain HPV types and cervical cancer, the findings may help to explain why women who are smokers or HIV-infected are at risk for this tumor. They also underscore the importance of smoking cessation in women's health.

The study, reported by Howard Minkoff and coworkers at SUNY Downstate and other centers, involved 1,797 HIV-infected and 496 uninfected women whose smoking and HPV status was monitored at six-month intervals from 1994 to 1998.

Smoking status was determined in interviews, HPV status by cervicovaginal lavage for HPV DNA testing. Other factors studied included age, T cell subset concentrations, anti-HIV drug regimen use, HIV RNA levels, oral contraceptive use, and sexual activity.

The investigators found that, regardless of smoking status, HIV-infected women were 3.9 times more likely than women not infected with HIV to have HPV infection at the outset of the study. When smoking was factored into the analysis, heightened HPV risk at the outset was seen only in HIV-infected women. HIV-infected women were also 3.13 times more likely to acquire HPV infection during the study, and smoking significantly increased HPV risk in such women.

Finally, both HIV-infected subjects and those who smoked were significantly more likely than their uninfected or nonsmoking counterparts to acquire persistent HPV infection (defined as occurring during the study and present at two consecutive visits).

Noting that persistent HPV infections have been shown to increase the risk of cervical cancer, Minkoff and coworkers commented that smoking and HIV infection may each alter the natural history of HPV infection to heighten tumor risk, and that the combination of smoking and HIV infection may be especially potent in this regard.

The putative mechanism(s) would involve immune deficiencies. HIV infection, of course, is a prime example of immunodeficiency disease. The investigators pointed out that smoking has been associated with impaired cellular, humoral, and mucosal immunity, and with deranged pro- and anti-inflammatory cytokine production as well.

Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines.

It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Virginia, IDSA is a professional society representing more than 7,500 physicians and scientists who specialize in infectious diseases. The Society's affiliate organization, the HIV Medicine Association (HIVMA), is the professional home for more than 2,500 physicians, scientists, and other health professionals dedicated to HIV/AIDS. For more information, visit www.idsociety.org.

Contact: Jeff Minerd
jminerd@idsociety.org
703-299-0200
Infectious Diseases Society of America

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