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Cui M, Song L, Mao R, Lyu Y, Ding L, Wang Z, Pei R, Yan J, Wu C, Li X, Jia H, Zhang L, Zhang M, Wang J, Wang J. Exposure to polycyclic aromatic hydrocarbons promotes the progression of low-grade cervical intraepithelial neoplasia: A population-based cohort study in China. Int J Cancer 2024. [PMID: 38733360 DOI: 10.1002/ijc.34990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Low-grade cervical intraepithelial neoplasia (CIN1) is an early stage of cervical cancer development. Previously, we reported that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of cervical precancerous lesions, especially in females with a high-risk human papillomavirus (HR-HPV) infection. However, the effects of PAHs on CIN1 progression remain unclear. A community-based prospective cohort study was conducted to evaluate the role of exposure to PAHs in the progression of CIN1. A total of 564 patients diagnosed with CIN1 were followed-up at 6, 12, and 24 months, post-diagnosis, to determine CIN1 reversion, persistence, and progression. Exposure to PAHs was determined by the urine 1-hydroxipayrene (1-OHP) level. Our results showed that the 1-OHP level was significantly higher in patients with CIN1 persistence/progression than in those with reversion (P < .05). High exposure to PAHs increased the risk of CIN1 persistence/progression, with hazard ratios (HR), 95% confidence intervals (CI) of (1.62, 1.24-2.67), (1.98, 1.42-2.75), and (2.37, 1.61-3.49) at 6, 12, and 24 months, post-diagnosis, respectively. The effect was enhanced with HR-HPV positivity, as determined at 6 (1.82, 1.24-2.67), 12 (3.02, 1.74-5.23), and 24 (2.51, 1.48-4.26) months, post-diagnosis. Moreover, the predictive value of exposure to PAHs for CIN1 persistence/progression was higher in HR-HPV-positive patients than in HR-HPV-negative patients. The results revealed that exposure to PAHs facilitated the malignant progression of CIN1 and hindered its reversal, particularly in patients with HR-HPV infection. Our findings provide novel insights into early prevention and intervention targeting the initiation and progression of cervical neoplasia.
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Affiliation(s)
- Meng Cui
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Li Song
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Rui Mao
- Questrom School of Business, Boston University, Boston, Massachusetts, USA
| | - Yuanjing Lyu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Ling Ding
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhilian Wang
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruixin Pei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jiaxin Yan
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Caihong Wu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoxue Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haixia Jia
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
- Shanxi Cancer Hospital, Taiyuan, China
| | - Le Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Mingxuan Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jiahao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jintao Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
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Nakigozi H, Ndejjo R, Bazeyo W, Nabaggala A, Achola C, Iga M, Kalyesubula S, Kanamwangi B, Mutungi G, Batte C, Mukunya D, Sserwanga L, Gemageine G, Oyoo CA, Nabadda S. Prevalence of genital high-risk human papillomavirus infections and associated factors among women living with human immunodeficiency virus in Uganda. BMC Cancer 2024; 24:243. [PMID: 38383366 PMCID: PMC10882885 DOI: 10.1186/s12885-024-11928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/27/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Women living with HIV are at risk for cervical dysplasia and cancer worldwide. In 2015, the World Health Organization (WHO) recommended that testing for high-risk HPV (hrHPV) infection be incorporated into cervical cancer screening programs using molecular nucleic acid tests (NATs) but this has not previously been done in Uganda. The country's coverage for Human Papilloma Virus (HPV) screening remains low at less than 10% for women aged 25-49 years. This study determined the genital prevalence of hrHPV infection and the associated factors among women living with HIV in Uganda. METHODS A descriptive cross-sectional study was conducted in 15 selected health facilities among participants who were on Antiretroviral therapy (ART). Participants who consented to participate were instructed on how to collect their own high vaginal swabs using a cervical brush for HPV molecular testing (HPV DNA or HPV RNA) and their demographics data was collected using a standard questionnaire. Laboratory diagnosis for HPV molecular testing was done using Gene xpert machines and Hologic Aptima Machine. Modified Poisson regression analysis was conducted to determine the associated factors. RESULTS This study involved 5856 HIV positive participants on ART. A total of 2006 out of 5856 (34.3%) participants had high risk HPV infections. HPV infections by genotypes were: HPV16 317(15.8%), HPV 18/45 308 (15.4%) and other high-risk HPV 1381 (68.8%). The independent factors associated with all hrHPV were parity, education level, having more than one partner, and engaging in early sex. Smoking was associated with HPV 16, HPV 18/45 and other hrHPV. Age was associated with all hrHPV, marital status with HPV 16, and occupation with HPV 16. CONCLUSIONS The prevalence of genital high-risk HPV infections among HIV positive women attending ART clinics in public facilities in Uganda was high. Other hrHPV genotype was the commonest compared to 18/45 and HPV 16. The integration of cervical cancer screening in ART programmes remains paramount to support the early detection of cervical cancer and Non-invasive self-collected urine and vaginal sampling for cervical cancer screening present an opportunity.
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Affiliation(s)
- Harriet Nakigozi
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda.
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Bazeyo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Annet Nabaggala
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Caroline Achola
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Moses Iga
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Simeon Kalyesubula
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Ben Kanamwangi
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Gerald Mutungi
- Department of Non-communicable Diseases, Ministry of Health, Kampala, Uganda
| | - Charles Batte
- Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Mukunya
- Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Lawrence Sserwanga
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Godfrey Gemageine
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Charles Akiya Oyoo
- Department of Non-communicable Diseases, Ministry of Health, Kampala, Uganda
| | - Susan Nabadda
- National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
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Li J, Jin H, Sun Y, Wang C, Chen H, Gong S, Jiang L. Reconnoitering correlation between human papillomavirus infection-induced vaginal microecological abnormality and squamous intraepithelial lesion (SIL) progression. BMC Womens Health 2024; 24:5. [PMID: 38167014 PMCID: PMC10763377 DOI: 10.1186/s12905-023-02824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the relationship between abnormal vaginal microecology and human papillomavirus (HPV) infection, as well as the squamous intraepithelial lesions (SIL) progression. METHODS A total of 383 patients diagnosed with HPV infection in our hospital between March 2017 and February 2022 were selected as the experimental group. In addition, several volunteers (n = 898) who underwent physical examination during the same period were randomly selected as the control group. Subsequently, we conducted several investigations, such as HPV detection and gene typing, examined vaginal microecological imbalances, and performed cytological examinations to analyze the correlation between microecological changes, different types of HPV infection, and SIL progression. RESULTS HPV detection primarily included single and high-risk types of HPV infections. Moreover, significant disparities in the vaginal microecological environment between patients with persistent HPV infection and the control group, as well as patients with low-grade and high-grade SIL (LSIL and HSIL), were observed. The regression analysis revealed a correlation between LSIL and microflora density, diversity, bacteriological vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonas vaginalis (TV), sialidase, as well as Lactobacillus. In addition, we identified an association between HSIL and pH, flora density, diversity, BV, VVC, candida vaginitis (CV), leukocyte esterase, catalase, and Lactobacillus levels. CONCLUSION These findings revealed a significant association between abnormal vaginal microecology and both HPV infection and the SIL progression.
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Affiliation(s)
- Jiawei Li
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Haihong Jin
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Yongmei Sun
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Chunhua Wang
- Department of Inspection Center, Qinhuangdao First Hospital, Qinhuangdao, Hebei, 066099, China
| | - Hongjuan Chen
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Shan Gong
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Li Jiang
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China.
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Zhao R, Sekar P, Bennis SL, Kulasingam S. A systematic review of the association between smoking exposure and HPV-related cervical cell abnormality among women living with HIV: Implications for prevention strategies. Prev Med 2023; 170:107494. [PMID: 37001607 DOI: 10.1016/j.ypmed.2023.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
This study aims to evaluate the association between smoking exposure and human papillomavirus (HPV)-related cervical abnormalities among women living with HIV (WLWH). By conducting a systematic review of the current literature, we evaluated the association between current active smoking and/or exposure to secondhand smoke (SHS) and the risk of cervical HPV incidence, prevalence, and clearance, as well as high-grade cervical intraepithelial neoplasm (HGCIN) incidence, prevalence, progression, and regression among WLWH. We conducted the literature search in Ovid Medline, Embase, and Scopus following the PRISMA guidelines. We determined the risk of bias of included studies using the Risk of Bias Assessment Tool for Nonrandomized Studies. Studies with the same effect measure were combined for a pooled estimate. We identified 15 studies that met the inclusion criteria for the final analysis, with a limited number of studies evaluating each study question. Among WLWH, current active smoking is associated with an increased risk of new HPV infections (HR = 1.33, 95% CI 1.10-1.60), HPV prevalence (ORpooled = 1.55, 95% CI 1.26-1.91), HGCIN incidence (HR = 1.5, 95% CI 1.2-2.0), and HGCIN prevalence (PR = 3.69, 95% CI 1.54-8.78). There was no significant association between current active smoking and HPV clearance. We did not identify any study that evaluated the association between SHS exposure and HPV-related cervical abnormalities among WLWH. Active smoking increases the risk of HPV infection and pre-cancer lesion development in WLWH. Considering smoking as an additional risk factor when designing tailored cervical cancer screening programs for WLWH is necessary in high smoking prevalence regions.
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Affiliation(s)
- Ran Zhao
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, 1300 S 2nd St, Minneapolis, MN 55454, USA.
| | - Preethiya Sekar
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Sarah L Bennis
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, 1300 S 2nd St, Minneapolis, MN 55454, USA
| | - Shalini Kulasingam
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, 1300 S 2nd St, Minneapolis, MN 55454, USA
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Malevolti MC, Lugo A, Scala M, Gallus S, Gorini G, Lachi A, Carreras G. Dose-risk relationships between cigarette smoking and cervical cancer: a systematic review and meta-analysis. Eur J Cancer Prev 2023; 32:171-183. [PMID: 36440802 DOI: 10.1097/cej.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cervical cancer (CC) is the fourth most frequent cancer worldwide. Cigarette smoking has been shown to influence CC risk in conjunction with human papillomavirus (HPV) infection. The aim of this study is to provide the most accurate and updated estimate of this association and its dose-response relationship. METHODS Using an innovative approach for the identification of original publications, we conducted a systematic review and meta-analysis of studies published up to January 2021. Random effects models were used to provide pooled relative risks (RRs) of CC for smoking status. Dose-response relationships were evaluated using one-stage random effects models with linear or restricted cubic splines models. RESULTS We included 109 studies providing a pooled RR of invasive CC and preinvasive lesions, respectively, of 1.70 [95% confidence interval (CI), 1.53-1.88] and 2.11 (95% CI, 1.85-2.39) for current versus never smokers, and, respectively, 1.13 (95% CI, 1.02-1.24) and 1.29 (95% CI, 1.15-1.46) for former versus never smokers. Considering HPV does not alter the positive association or its magnitude. Risks of CC sharply increased with few cigarettes (for 10 cigarettes/day, RR = 1.72; 95% CI, 1.34-2.20 for invasive CC and RR = 2.13; 95% CI, 1.86-2.44 for precancerous lesions). The risk of CC increased with pack-years and smoking duration and decreased linearly with time since quitting, reaching that of never smokers about 15 years after quitting. CONCLUSION This comprehensive review and meta-analysis confirmed the association of smoking with CC, independently from HPV infection. Such association rose sharply with smoking intensity and decreased after smoking cessation.
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Affiliation(s)
| | - Alessandra Lugo
- Department of Environmental Health Science, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - Marco Scala
- Department of Environmental Health Science, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - Silvano Gallus
- Department of Environmental Health Science, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence
| | - Alessio Lachi
- Department of Statistics, Informatics and Applications "Giuseppe Parenti", University of Florence, Florence, Italy
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence
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Saldaña-Rodríguez P, Bahena-Román M, Delgado-Romero K, Madrid-Marina V, Torres-Poveda K. Prevalence and Risk Factors for High-Risk Human Papillomavirus Infection and Cervical Disorders: Baseline Findings From an Human Papillomavirus Cohort Study. Cancer Control 2023; 30:10732748231202925. [PMID: 37751562 PMCID: PMC10524074 DOI: 10.1177/10732748231202925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only. OBJECTIVES We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population. METHODS Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis. RESULTS A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions. CONCLUSIONS The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.
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Affiliation(s)
- Paula Saldaña-Rodríguez
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Margarita Bahena-Román
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Karina Delgado-Romero
- Centro de Atención para la Salud de la Mujer (CAPASAM) (Center for Women's Health), Health Services of the State of Morelos, Cuernavaca, Mexico
| | - Vicente Madrid-Marina
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Consejo Nacional de Humanidades Ciencias y Tecnologías (CONAHCYT), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Ewing AP, Alalwan MA, Brown JA, Adekunle TE, Korley ND, Nafiu TC, Coughlin EC, Parvanta CP, Meade CD, Gwede CK, Best AL. Physically fit with a higher cancer risk? Influences of cervical cancer screening among a sample of physically active women ages 21-49 living in the United States. Prev Med Rep 2022; 30:101978. [PMID: 36157713 PMCID: PMC9494240 DOI: 10.1016/j.pmedr.2022.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
To achieve the lowest risk level for various cancers, individuals would engage in several healthy lifestyle behaviors and age-eligible cancer screenings as recommended. Nonetheless, research has largely omitted exploration of concurrent primary and secondary prevention behaviors. This study was designed to explore influences of cervical cancer screening among physically active women who reported participation in recreational sports. U.S. based women between the ages of 21–49, who had never been diagnosed with cancer, were eligible to complete a web-based survey. Logistic regression analyses were conducted using SAS 9.4. On average, women were 31 years of age (N = 394) and self-identified as Black (51.3 %). Although low overall (30.7 %), higher odds of cervical cancer screening were associated with age (OR = 1.06, 95 % CI = 1.03–1.10), employment (OR = 2.43, 95 % CI = 1.14–5.18), knowledge of cancer-related risk behaviors (OR = 4.04, 95 % CI = 1.33–12.28), routine doctor’s visit (OR = 4.25, 95 % CI = 1.56–11.54), and team-based vs individual-based sport participation (OR = 1.95, 95 % CI = 1.13–3.34). Our study provides insight into the health profile of physically active women, ages 21–49, as it relates to risks for cervical cancer. Screening uptake among this diverse sample was much lower than the general population and national goals set by Healthy People 2030. Interventions should be tailored to increase knowledge of cancer-related risk behaviors, access to healthcare, and recommended cervical cancer screenings among even assumed-to-be healthy populations.
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Affiliation(s)
- A P Ewing
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - M A Alalwan
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - J A Brown
- University of North Carolina Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health (JAB) CB # 7400 135 Dauer Drive, Chapel Hill NC 27599, USA
| | - T E Adekunle
- School of Public Health and Information Sciences (SPHIS), University of Louisville (TEA) 485 E Gray St, Louisville KY 40202, USA
| | - N D Korley
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - T C Nafiu
- The Ohio State University College of Public Health, Division of Epidemiology (APE, MAA, NDK, TCN), 1841 Neil Ave Building 293, Columbus OH 43210, USA
| | - E C Coughlin
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - C P Parvanta
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - C D Meade
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior (CDM, CKG) 4117 E Fowler Ave, Tampa, FL 33612, USA
| | - C K Gwede
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior (CDM, CKG) 4117 E Fowler Ave, Tampa, FL 33612, USA
| | - A L Best
- College of Public Health, University of South Florida (ECC, CPP, ALB) 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
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Bortolli APR, Vieira VK, Treco IC, Pascotto CR, Wendt GW, Lucio LC. GSTT1 and GSTM1 polymorphisms with human papillomavirus infection in women from southern Brazil: a case-control study. Mol Biol Rep 2022; 49:6467-6474. [PMID: 35507115 PMCID: PMC9065665 DOI: 10.1007/s11033-022-07475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Important risk factors for the most common sexually transmitted infection (STI) in the world, human papillomavirus (HPV), include early sexual activity, use of contraceptives, tobacco smoking, and immunological and genetic factors. This study aimed to investigate the relationship between GSTM1 and GSTT1 polymorphisms and HPV infection and associated risk factors in a group of women assisted in the public health system of southwestern Paraná, Brazil. METHODS AND RESULTS A case-control study was designed with 21 women with HPV matched by age in the case group and 84 women without the virus in the control group. Viral detection was conducted via polymerase chain reaction (PCR) and GSTM1 and GSTT1 genotyping by Multiplex PCR. The results showed that the GSTT1 null allele was a protective factor against infection (ORadj 0.219; 95% CI 0.078-0.618; p = 0.004). No relationship was observed for the GSTM1 gene. Smoking was defined as a risk factor (ORadj 3.678; 95% CI 1.111-12.171; p = 0.033), increasing the chances of HPV by up to 3.6 times. CONCLUSION This study showed, for the first time, the relationship between GSTM1 and GSTT1 genetic polymorphisms and HPV. We found that this relationship protected women from southern Brazil from viral infection, but not from susceptibility.
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Affiliation(s)
- Ana Paula Reolon Bortolli
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Valquíria Kulig Vieira
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Indianara Carlotto Treco
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Claudicéia Risso Pascotto
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Guilherme Welter Wendt
- Centro de Ciências da Saúde, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
| | - Léia Carolina Lucio
- Graduate Courses in Sciences Applied to Health, Universidade Estadual do Oeste do Paraná, Francisco Beltrão, Paraná, Brazil
- Department of Health Sciences, Universidade Estadual do Oeste do Paraná, PR-182 Km 02, Bairro Água Branca, Francisco Beltrão, Paraná, Brazil
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Patterson JG, Borger TN, Burris JL, Conaway M, Klesges R, Ashcraft A, Hauser L, Clark C, Wright L, Cooper S, Smith MC, Dignan M, Kennedy-Rea S, Paskett ED, Anderson R, Ferketich AK. A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program. Addict Sci Clin Pract 2022; 17:11. [PMID: 35164857 PMCID: PMC8842942 DOI: 10.1186/s13722-022-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. METHODS The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. DISCUSSION Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
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Affiliation(s)
- Joanne G Patterson
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Lindsay Hauser
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Connie Clark
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | | | - Sarah Cooper
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Merry C Smith
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Stephenie Kennedy-Rea
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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10
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Schrank T, Weir W, Lal A, Landess L, Lenze N, Hackman T. Quantifying smoking exposure, genomic correlates, and related risk of treatment failure in p16+ squamous cell carcinoma of the oropharynx. Laryngoscope Investig Otolaryngol 2021; 6:1376-1382. [PMID: 34938877 PMCID: PMC8665424 DOI: 10.1002/lio2.695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES HPV-associated (p16+) squamous cell carcinoma of the oropharynx (OPSCC) has improved survival as compared to HPV-negative, smoking-associated disease. Intermediate outcomes have been noted in patients with p16+ tumors and smoking exposure. However, the extent of smoking exposure required for outcomes to decrease has not been delineated due to low failure rates and poor availability of quantitative tobacco smoke exposure data. Our primary objective is to characterize the dose-dependent relationship between recurrence-free survival (RFS) and tobacco smoke exposure in p16+ OPSCC and secondarily correlate tobacco smoke exposure with genomic alterations. METHODS Single institution chart review was performed of patients diagnosed with p16+ OPSCC from 2003 to 2015. Patients were excluded if staging, treatment details, recurrence status, or smoking exposure in pack-years were not available. Two hundred and forty-four patients were included. RESULTS Patients with 25 pack-years or greater smoking history exhibited a dose-dependent decrease in RFS compared to never smokers. This was robust to multivariate analysis for including staging and demographic factors. Forty-three patients with available targeted tumor sequencing data were identified. A strong trend was observed for increased C to A transversion mutations above 25 pack-years, which are known to be associated with exposure to tobacco smoke. Similarly, the proportion of COSMIC Signature 4 mutations were also found to be more common in patients with more than 25 pack-years of smoking exposure. CONCLUSION Evidence-based smoking exposure thresholds are needed to define inclusion criteria for trials of de-escalation therapy for p16+ OPSCC. Patients with smoking exposure greater than 20 pack-years have increased risk of recurrence and a distinct pattern of genomic alterations. Further studies are needed to delineate the potential consequences of mild smoking exposure. Smoking-related mutational signatures may hold potential for biomarker development in p16+ OPSCC. LEVEL OF EVIDENCE 2B.
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Affiliation(s)
- Travis Schrank
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer Center—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - William Weir
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Asim Lal
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Lee Landess
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Nicholas Lenze
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Trevor Hackman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
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11
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Cervical Squamous Intraepithelial Lesions Are Associated with Differences in the Vaginal Microbiota of Mexican Women. Microbiol Spectr 2021; 9:e0014321. [PMID: 34643408 PMCID: PMC8515943 DOI: 10.1128/spectrum.00143-21] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cervical cancer is an important health concern worldwide and is one of the leading causes of death in Mexican women. Previous studies have shown changes in the female genital tract microbe community related to human papillomavirus (HPV) infection and cervical cancer; yet, this link remains unexplored in many human populations. This study evaluated the vaginal bacterial community among Mexican women with precancerous squamous intraepithelial lesions (SIL). We sequenced the V3 region of the 16S rRNA gene in cervical samples from 228 Mexican women, including 121 participants with SIL, most of which were HPV positive, and 107 healthy women without HPV infection or SIL. The presence of SIL was associated with changes in composition (beta diversity) and with a higher species richness (Chao1). A comparison of HPV-positive women with and without SIL showed that microbiota changes occurred even in the absence of SIL. Multivariate association with linear models (MaAsLin) analysis yielded independent associations between HPV infection and an increase in the relative abundance of Brachybacterium conglomeratum and Brevibacterium aureum as well as a decrease in two Lactobacillus iners operational taxonomic units (OTUs). We also identified a positive independent association between HPV-16, the most common HPV subtype linked to SIL, and Brachybacterium conglomeratum. Our work indicates that HPV infection leading to SIL is primarily associated with shifts in vaginal microbiota composition, some of which may be specific to this human population. IMPORTANCE Human papillomavirus (HPV) plays a critical role in cervical carcinogenesis but is not sufficient for cervical cancer development, indicating the involvement of other factors. The vaginal microbiota is an important factor in controlling infections caused by HPV, and, depending on its composition, it can modulate the microenvironment in vaginal mucosa against viral infections. Ethnic and sociodemographic factors influence differences in vaginal microbiome composition, which underlies the dysbiotic patterns linked to HPV infection and cervical cancer across different populations of women. Here, we provide evidence for associations between vaginal microbiota patterns and HPV infection linked to ethnic and sociodemographic factors. To our knowledge, this is the first report of the species Brevibacterium aureum and Brachybacterium conglomeratum linked to HPV infection or squamous intraepithelial lesions (SIL).
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12
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The characteristics and risk factors of human papillomavirus infection: an outpatient population-based study in Changsha, Hunan. Sci Rep 2021; 11:15128. [PMID: 34302031 PMCID: PMC8302608 DOI: 10.1038/s41598-021-94635-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/28/2021] [Indexed: 11/08/2022] Open
Abstract
This cross-sectional study investigated the characteristics of cervical HPV infection in Changsha area and explored the influence of Candida vaginitis on this infection. From 11 August 2017 to 11 September 2018, 12,628 outpatient participants ranged from 19 to 84 years old were enrolled and analyzed. HPV DNA was amplified and tested by HPV GenoArray Test Kit. The vaginal ecology was detected by microscopic and biochemistry examinations. The diagnosis of Candida vaginitis was based on microscopic examination (spores, and/or hypha) and biochemical testing (galactosidase) for vaginal discharge by experts. Statistical analyses were performed using SAS 9.4. Continuous and categorical variables were analyzed by t-tests and by Chi-square tests, respectively. HPV infection risk factors were analyzed using multivariate logistic regression. Of the total number of participants, 1753 were infected with HPV (13.88%). Females aged ≥ 40 to < 50 years constituted the largest population of HPV-infected females (31.26%). The top 5 HPV subtypes affecting this population of 1753 infected females were the following: HPV-52 (28.01%), HPV-58 (14.83%), CP8304 (11.47%), HPV-53 (10.84%), and HPV-39 (9.64%). Age (OR 1.01; 95% CI 1-1.01; P < 0.05) and alcohol consumption (OR 1.30; 95% CI 1.09-1.56; P < 0.01) were found to be risk factors for HPV infection. However, the presence of Candida in the vaginal flora was found to be a protective factor against HPV infection (OR 0.62; 95% CI 0.48-0.8; P < 0.001). Comparing with our previous study of 2016, we conclude that the subtype distribution of HPV infection is relatively constant in Changsha. Our data suggest a negative correlation between vaginal Candida and HPV, however, more radical HPV management is required in this area for perimenopausal women and those who regularly consume alcohol.
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13
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Goetgebuer RL, Kreijne JE, Aitken CA, Dijkstra G, Hoentjen F, de Boer NK, Oldenburg B, van der Meulen AE, Ponsioen CIJ, Pierik MJ, van Kemenade FJ, de Kok IMCM, Siebers AG, Manniën J, van der Woude CJ, de Vries AC. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. J Crohns Colitis 2021; 15:1464-1473. [PMID: 33609353 PMCID: PMC8653760 DOI: 10.1093/ecco-jcc/jjab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Women with inflammatory bowel disease [IBD] may be at higher risk for cervical intraepithelial neoplasia [CIN]. However, data are conflicting. The aim of this study was to assess the risk of high-grade dysplasia and cancer [CIN2+] in IBD women and identify risk factors. METHODS Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort [PSI] from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database [PALGA], from 2000 to 2016. Patients were frequency-matched 1:4 to a general population cohort. Standardised detection rates [SDR] were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios [IRR] and risk factors were identified in multivariable analysis. RESULTS Cervical records were available from 2098 IBD women [77%] and 8379 in the matched cohort; median follow-up was 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95% confidence interval [CI] 1.05-1.52). Women with IBD had an increased risk of CIN2+ [IRR 1.66, 95% CI 1.21-2.25] and persistent or recurrent CIN during follow-up (odds ratio [OR] 1.89, 95% CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic [L3] or upper gastrointestinal [GI] [L4]). CIN2+ risk was not associated with exposure to immunosuppressants. CONCLUSIONS Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of human papillomavirus [HPV] vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.
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Affiliation(s)
- R L Goetgebuer
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - J E Kreijne
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - C A Aitken
- Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands
| | - G Dijkstra
- University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, The Netherlands
| | - F Hoentjen
- Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, The Netherlands
| | - N K de Boer
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - B Oldenburg
- University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, The Netherlands
| | - A E van der Meulen
- Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, The Netherlands
| | - C I J Ponsioen
- Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, the Netherlands
| | - M J Pierik
- Maastricht University Medical Center, Gastroenterology and Hepatology, Maastricht, The Netherlands
| | - F J van Kemenade
- Erasmus MC, University Medical Center, Pathology, Rotterdam, The Netherlands
| | - I M C M de Kok
- Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands
| | - A G Siebers
- PALGA, The Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands, Houten, The Netherlands,Radboud University Medical Center, Pathology, Nijmegen, The Netherlands
| | - J Manniën
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, The Netherlands
| | - C J van der Woude
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - A C de Vries
- Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands,Corresponding author: Annemarie C. de Vries, MD, PhD, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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14
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Xie T, Wang Y, Zou Z, He J, Yu Y, Liu Y, Bai J. Environmental Tobacco Smoke Exposure and Breastfeeding Duration Influence the Composition and Dynamics of Gut Microbiota in Young Children Aged 0-2 Years. Biol Res Nurs 2020; 23:382-393. [PMID: 33267614 DOI: 10.1177/1099800420975129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The colonization characteristics of infant gut microbiota are influenced by many factors at various stages, but few studies have explored the longitudinal effects of environmental tobacco smoke exposure and quantitative breastfeeding duration on young children' gut microbiota. We explored the effects of smoke exposure and breastfeeding duration on gut microbiota by following 37 maternal and children pairs in China for 2 years. We collected the demographic information, frequency of smoke exposure, breastfeeding duration, and fecal samples (mothers in the late pregnancy and infants at 6, 12, and 24 months), and analyzed the microbiota results using the V3-V4 gene sequence of 16S rRNA. The diversity of gut microbiota in children was the highest at 24 months and most similar to that in mothers. Breastfeeding duration was positively correlated with Lactobacillus and negatively correlated with Clostridium_sensu_stricto_1. The α diversity of microbiota and the relative abundance of [Ruminococcus]_gnavus_group was higher in the non-smoke exposed group. The higher the smoke exposure, the higher the relative abundance of Megasphaera. Prolonged breastfeeding and reduced smoke exposure are beneficial to the diversity and composition of gut microbiota in young children.
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Affiliation(s)
- Tianqu Xie
- School of Health Sciences, 12390Wuhan University, China
| | - Yuchen Wang
- School of Health Sciences, 12390Wuhan University, China
| | - Zhijie Zou
- School of Health Sciences, 12390Wuhan University, China
| | - Jing He
- School of Health Sciences, 12390Wuhan University, China
| | - Yun Yu
- School of Health Sciences, 12390Wuhan University, China
| | - Yanqun Liu
- School of Health Sciences, 12390Wuhan University, China
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, 1371Emory University, Atlanta, GA, USA
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15
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Chemopreventive Role of Apigenin against the Synergistic Carcinogenesis of Human Papillomavirus and 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone. Biomedicines 2020; 8:biomedicines8110472. [PMID: 33158065 PMCID: PMC7694184 DOI: 10.3390/biomedicines8110472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022] Open
Abstract
Tobacco smoke and human papillomavirus (HPV) are both crucial causes of cancer, and their cooperative carcinogenesis has drawn more attention in recent years. Apigenin (AP), a typical flavonoid abundantly found in flowers of plants, vegetables, and fruits, has been demonstrated to exert an anti-carcinogenic effect on various types of cancer. In this study, we investigated the capability of AP against malignant transformation and DNA damage of immortalized human esophageal epithelial (SHEE) cells induced by the synergism of HPV18 and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). The results indicated that the enhancement of migration, invasion, and proliferation ability of SHEE cells induced by HPV and NNK could be effectively inhibited by AP. Moreover, the levels of pyridyloxybutylated (POB)-DNA adducts induced by NNK via P450-catalyzed metabolic activation could also be significantly suppressed by AP. Further analyses on the molecular mechanism revealed that AP inhibited the synergistic carcinogenesis of NNK and HPV on SHEE cells by reducing the expression of mutp53, CDK4, Cyclin D1, and p-Rb (Ser 780), increasing caspase-3 activity, thereby arresting the cell cycle at G1 phase and promoting apoptosis of SHEE cells. We hypothesize that the decrease in NNK-induced POB-DNA adduct levels is related to the deactivation of P450 by AP, which needs to be confirmed in future studies. This study highlights that AP may be employed as a promising chemopreventive agent against cancers in smokers with an HPV infection.
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16
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Liu J, Luo M, Zhang Y, Cao G, Wang S. Association of high-risk human papillomavirus infection duration and cervical lesions with vaginal microbiota composition. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1161. [PMID: 33241010 PMCID: PMC7576078 DOI: 10.21037/atm-20-5832] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Cervical cancer is reportedly caused by the synergistic effects of persistent high-risk human papillomavirus (HPV) infection. Cervical microbiota represent a unique and dynamically changing microecological system that is directly exposed to the vagina. The relationship between HPV and the composition of the cervical microbiome has long been a primary focus of research. Methods To determine the specific differential florae throughout the process of cervical cancer development, in the present study, 16S rRNA sequencing was combined with KEGG pathway enrichment analysis to analyse five groups of cervical scraping samples with increasing durations of HPV infection and cervical intraepithelial neoplasia pathological classification. Results The findings revealed that decreasing levels of probiotics, including Shuttleworthia, Prevotella, Lactobacillus, and Sneathia, and increasing levels of pathogenic bacteria, including Dispar, Streptococcus, and Faecalibacterium prausnitzii, could be the direct result of early HPV infection. Other pathogenic bacteria, such as Bifidobacteriaceae, might represent key factors in cancer progression. Additionally, KEGG pathway enrichment analysis indicated that HPV infection directly inhibits multiple pathways, including those of sporulation, porphyrin and chlorophyll metabolism, arginine and proline metabolism, isoquinoline alkaloid biosynthesis, and ansamycin biosynthesis, which may lead to the development of early symptoms of cervical cancer. Biomarkers were predicted based on operational taxonomic unit (OTU) abundance data, and OTU851726 and OTU715913 were undoubtedly the best potential indicators of cervical cancer. Conclusions The findings of the present study could assist with the development of a guideline for screening new clinical drugs for cervical cancer.
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Affiliation(s)
- Jun Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mei Luo
- Department of Obstetrics and Gynecology, Lu-He Teaching Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangming Cao
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuzhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Liang Z, Xu C, Ji AL, Liang S, Kan HD, Chen RJ, Lei J, Li YF, Liang ZQ, Cai TJ. Effects of short-term ambient air pollution exposure on HPV infections: A five-year hospital-based study. CHEMOSPHERE 2020; 252:126615. [PMID: 32443276 DOI: 10.1016/j.chemosphere.2020.126615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Human papillomavirus (HPV) infections are common sexually-transmitted diseases among reproductive-aged women with increasing concern. Until now, there are no prior study about the association between HPV infections and ambient air pollution. This study aimed to explore the relationship between short-term exposure to ambient pollutants and daily outpatient visits for HPV infections in China. Data of daily outpatient visits for HPV infections were obtained from January 1, 2014 to December 31, 2018 (1826 days). Over-dispersed Poisson generalized additive models were applied by adjusting weather conditions and day of the week. We identified a total of 39,746 cases for HPV infections. A 10 μg/m3 increase of PM10, PM2.5, SO2, and NO2 or a 0.1 mg/m3 rise of CO in concurrent day (lag 0) concentrations was related to an elevation of 0.822% (95% Cl: 0.282%, 1.36%), 1.05% (95% Cl: 0.280%, 1.81%), 5.72% (95% Cl: 1.79%, 9.65%), 5.02% (95% Cl: 3.45%, 6.60%), and 2.40% (95% Cl: 1.43%, 3.37%) in daily outpatient-visits for HPV infections, respectively. The association was more significant in those women aged 41 or over. As for 10 μg/m3 increase of O3, a -1.33% (95% Cl: -2.13%, -0.530%) change was observed on the lag 03 and such effects appeared to be more obvious in the aged 18-40 group. Our results provided the first evidence that short-term exposure to ambient pollutants was related to, which may be indirectly, the increased risk of HPV infections while O3 may act as a "protective" factor.
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Affiliation(s)
- Zhen Liang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Chen Xu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Troop 94498 of PLA, Nanyang, 474350, China
| | - Ai-Ling Ji
- Department of Preventive Medicine & Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China
| | - Shi Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China; Brigham Young University Provo, UT 84602, 801-422-4636, USA
| | - Hai-Dong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Ren-Jie Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Jie Lei
- Department of Internal Medicine, Hui Long-Ba Town Hospital, Chongqing, 401335, China
| | - Ya-Fei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhi-Qing Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Tong-Jian Cai
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob Induc Dis 2020; 18:60. [PMID: 32765200 PMCID: PMC7398598 DOI: 10.18332/tid/123845] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.
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Affiliation(s)
- Chen Jiang
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Chen
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxuan Xie
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
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Du X, Li M, Zhou Y, Yang H, Isachenko V, Takagi T, Meng Y. Evidence of Passive Smoking as a Risk Factor of High-Grade Squamous Intraepithelial Lesion: A Case-Control Study. Biol Pharm Bull 2020; 43:1061-1066. [DOI: 10.1248/bpb.b19-01098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Xinxin Du
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne
| | - Mingxia Li
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital
| | - Yi Zhou
- Laboratory of Pharmainformatics and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Hao Yang
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People’s Hospital of Inner Mongolia Medical University
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne
| | - Tatsuya Takagi
- Laboratory of Pharmainformatics and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Yuanguang Meng
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People’s Hospital of Inner Mongolia Medical University
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Zhuang Z, Li J, Sun G, Cui X, Zhang N, Zhao L, Chan PKS, Zhong R. Synergistic Effect between Human Papillomavirus 18 and 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone on Malignant Transformation of Immortalized SHEE Cells. Chem Res Toxicol 2019; 33:470-481. [PMID: 31874558 DOI: 10.1021/acs.chemrestox.9b00371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zhuochen Zhuang
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Jintao Li
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Guohui Sun
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Xin Cui
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Na Zhang
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Lijiao Zhao
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
| | - Paul K. S. Chan
- Departments of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Rugang Zhong
- Beijing Key Laboratory of Environmental and Viral Oncology, College of Life Sciences and Bioengineering, Beijing University of Technology, Beijing 100124, China
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Joo EJ, Chang Y, Kwon MJ, Cho A, Cheong HS, Ryu S. High-Risk Human Papillomavirus Infection and the Risk of Cardiovascular Disease in Korean Women. Circ Res 2019; 124:747-756. [PMID: 30727837 DOI: 10.1161/circresaha.118.313779] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
RATIONALE Until now, no cohort studies have evaluated the relationship between high-risk human papillomavirus (HPV) infection and new-onset cardiovascular diseases (CVD). OBJECTIVE We investigated an association between high-risk HPV infection and the development of CVD. METHODS AND RESULTS We conducted a cohort study of 63 411 women aged 30 or older without CVD at baseline who underwent a high-risk HPV test and were followed annually or biennially from 2011 to 2016. CVD was ascertained through the linkage to the Health Insurance and Review Agency database. A Cox-proportional hazards regression model was used to estimate adjusted hazard ratios (HRs) with 95% CIs of incident CVD. The prevalence of high-risk HPV infection was 7.6%. During 261 598.9 person-years of follow-up, 1122 cases of new-onset CVD were identified (incidence rate of 4.3 per 103 person-years). High-risk HPV infection was significantly associated with incident CVD. After adjustment for possible confounders, and high sensitivity C-reactive protein, a significant association between high-risk HPV infection and incident CVD was still observed, with a corresponding HR (95% CI) of 1.25 (1.03-1.52). This association was stronger among individuals with obesity and those with metabolic syndrome. Multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.10 (0.87-1.39) in the nonobese, whereas corresponding HR (95% CI) was 1.73 (1.19-2.51) in those with obesity ( P for interaction by obesity=0.02). Similarly, multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.09 (0.87-1.36) in those without metabolic syndrome and 1.99 (1.28-3.08) in those with MetS ( P for interaction=0.05). CONCLUSION In this large cohort, high-risk HPV infection was significantly associated with an increased risk of developing CVD, especially in obese individuals and those with MetS, indicating that high-risk HPV might affect CVD risk with possible effect modification by obesity and MetS.
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Affiliation(s)
- Eun-Jeong Joo
- From the Division of Infectious Diseases, Department of Internal Medicine (E.-J.J., H.S.C.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center (Y.C., A.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine (Y.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (Y.C., S.R.)
| | - Min-Jung Kwon
- Department of Laboratory Medicine (M.-J.K.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ara Cho
- Center for Cohort Studies, Total Healthcare Center (Y.C., A.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hae Suk Cheong
- From the Division of Infectious Diseases, Department of Internal Medicine (E.-J.J., H.S.C.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center (Y.C., A.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Occupational and Environmental Medicine (Y.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (Y.C., S.R.)
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Abstract
Human papillomavirus (HPV) is the first identified necessary cause of human cancers and is associated with nearly 100% of all cervical cancers. Compared to the general female populations, HIV+ women have higher prevalence and incidence of cervical HPV infections, higher risks of persistent HPV infections and subsequent cervical intraepithelial lesions, and a higher incidence of cervical cancer. Although the wide use of combined antiretroviral therapy (cART) has improved the immune function and the longevity of HIV+ women, the incidence of cervical cancer in HIV+ women has not declined. For HIV+ women who follow routine cervical cancer screenings, their incidence of cervical cancer is comparable to that in HIV-negative women. Thus, adherence to the recommended cervical cancer screening is still critical for HIV+ women to prevent cervical cancer. Prophylactic HPV vaccines may also benefit HIV+ women, but prospective studies are needed to determine the effectiveness of HPV vaccination on reducing cervical cancer incidence in HIV+ women.
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Affiliation(s)
- Ping Du
- Department of Medicine, Department of Public Health Sciences, Penn State Hershey College of Medicine, 90 Hope Drive, Suite 2200, A210, Hershey, PA, USA.
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23
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High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era. Enferm Infecc Microbiol Clin 2017; 36:555-562. [PMID: 29208455 DOI: 10.1016/j.eimc.2017.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/02/2017] [Accepted: 10/12/2017] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Anal cancer is one of the most common non-AIDS defining malignancies, especially in men who have sex with men and women living with HIV (WLHIV). OBJECTIVES To evaluate the prevalence and incidence of precursor lesions (high-grade squamous intraepithelial lesions [HSIL]) and anal cancer in our cohort of women and to compare them to cervical lesions; to calculate the percentage of patients that acquire and clear oncogenic genotypes (HR-HPV) in the anal canal; and to determine predictive factors for anal HPV infection. PATIENTS AND METHODS Prospective-longitudinal study (May 2012-December 2016). At baseline (V1) and follow up visits, anal mucosa samples were taken in liquid medium for cytology and HPV PCR. In cases of abnormal anal cytology and/or positive HR-HPV PCR results, a high resolution anoscopy was performed. Patients were also referred to the gynaecologist. RESULTS Ninety five women with an average age of 43.7years were included. At baseline, 11.6% had cervical abnormalities (4.1% CIN1, 2.2% CIN2/3, 1.1% cervical cancer), 64.3% anal abnormalities (50% LSIL/AIN1, 9.5% HSIL/AIN2/3 and 2.4% anal cancer) and 49.4% had HR-HPV genotypes. During 36months of follow up, the incidence of anal HSIL was 16×1,000 person-years; 14.8% acquired HR-HPV genotypes and 51.2% cleared them, P=.007. No patients presented CIN1/2/3/ or cervical cancer. In the multivariate analysis we found the following predictive factors for HR-HPV infection: smoking (RR: 1.55, 95%CI: 0.99-2.42), number of sexual partners >3 (RR: 1.69; 95%CI: 1.09-2.62), cervical and anal dysplasia (RR: 1.83; 95%CI: 1.26-2.67) and (RR: 1.55; 95%CI: 1.021-2.35), respectively. CONCLUSIONS Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates, prevalence and incidence of HSIL were still high and greater than cervical HSIL. Therefore, screening for these lesions should perhaps be offered to all WLHIV.
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Haque S, Sinha N, Ranjit S, Midde NM, Kashanchi F, Kumar S. Monocyte-derived exosomes upon exposure to cigarette smoke condensate alter their characteristics and show protective effect against cytotoxicity and HIV-1 replication. Sci Rep 2017; 7:16120. [PMID: 29170447 PMCID: PMC5701054 DOI: 10.1038/s41598-017-16301-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/10/2017] [Indexed: 01/10/2023] Open
Abstract
Smoking is known to exacerbate HIV-1 pathogenesis, especially in monocytes, through the oxidative stress pathway. Exosomes are known to alter HIV-1 pathogenesis through inter-cellular communication. However, the role of exosomes in smoking-mediated HIV-1 pathogenesis is unknown. In this study, we investigated the effect of cigarette smoke condensate (CSC) on the characteristics of monocyte-derived exosomes and their influence on HIV-1 replication. Initially, we demonstrated that CSC reduced total protein and antioxidant capacity in exosomes derived from HIV-1-infected and uninfected macrophages. The exosomes from CSC-treated uninfected cells showed a protective effect against cytotoxicity and viral replication in HIV-1-infected macrophages. However, exosomes derived from HIV-1-infected cells lost their protective capacity. The results suggest that the exosomal defense is likely to be more effective during the early phase of HIV-1 infection and diminishes at the latter phase. Furthermore, we showed CSC-mediated upregulation of catalase in exosomes from uninfected cells, with a decrease in the levels of catalase and PRDX6 in exosomes derived from HIV-1-infected cells. These results suggest a potential role of antioxidant enzymes, which are differentially packaged into CSC-exposed HIV-1-infected and uninfected cell-derived exosomes, on HIV-1 replication of recipient cells. Overall, our study suggests a novel role of exosomes in tobacco-mediated HIV-1 pathogenesis.
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Affiliation(s)
- Sanjana Haque
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Namita Sinha
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Sabina Ranjit
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Narasimha M Midde
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, 20110, USA
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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