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Infectious Diseases in Obstetrics and Gynecology
Volume 2008, Article ID 587082, 7 pages
http://dx.doi.org/10.1155/2008/587082
Research Article

The Relationship between Cocaine Use and Human Papillomavirus Infections in HIV-Seropositive and HIV-Seronegative Women

1Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, Brooklyn, NY 11219, USA
2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
3Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD 20892, USA
4Department of Medicine, The University of California, San Francisco (UCSF), San Francisco, CA 94143, USA
5Department of Internal Medicine, University of Southern California School of Medicine, Los Angeles, CA 90033, USA
6Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
7International Mailman School of Public Health, Columbia University, New York, NY 10032, USA
8Department of Medicine, School of Medicine, Georgetown University, Washington, DC 20007, USA
9Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
10Department of Pediatrics, Albert Einstein College of Medicine, Yeshiva University, 1400 Pelham Parkway South, Bronx, NY 10033, USA

Received 30 November 2007; Accepted 26 February 2008

Academic Editor: Harold Wiesenfeld

Copyright © 2008 Howard Minkoff et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. Animal data suggest that cocaine has an immunosuppressive effect, but no human studies have been conducted to assess the relation of cocaine use with human papillomavirus (HPV) infection, the viral cause of cervical cancer. Since both cocaine use and HPV infection are common among HIV-positive women, we sought to determine whether use of cocaine and/or crack influences the natural history of HPV among women with or at high risk of HIV. Methods. Women enrolled in the Women's Interagency HIV Study (2278 HIV-seropositive and 826 high-risk seronegative women) were examined every six months for up to 9.5 years with Pap smear, collection of cervicovaginal lavage (CVL) samples, and detailed questionnaires regarding health and behavior, including use of crack and cocaine (crack/cocaine). CVLs were tested for HPV DNA by PCR, with genotyping for over forty HPV types. Results. In multivariate logistic regression models, censoring women treated for cervical neoplasia, crack/cocaine use within the last six months was associated with prevalent detection of oncogenic HPV DNA (odds ratio [OR] = 1.30 (1.09–1.55)), and with oncogenic HPV-positive squamous intraepithelial lesions (SIL) (OR = 1.70 (1.27–2.27)), following adjustment for age, race, HIV-serostatus, and CD4+ T-cell count, the number of sexual partners in the past six months, and smoking. In multivariate Cox models crack/cocaine use was also associated with a trend that approached significance in regard to incident detection of oncogenic HPV-positive SIL (HR = 1.51, 95% CI 0.99–2.30), and while the rate of oncogenic HPV clearance was not related to cocaine use, the clearance of any SIL was significantly lower in those with versus those without recent crack/cocaine use (HR = 0.57, 95% CI 0.34–0.97). Conclusions. Cocaine use is associated with an increased risk of detection of both prevalent and incident oncogenic HPV infection, as well as an increased risk of HPV-positive SIL over time.