Sadeep Shrestha

Case-Control Study of Cervicovaginal β/γ–Human Papillomavirus Infection in Women With Human Immunodeficiency Virus and Its Relation to Incident Cervical Precancer

Abstract We studied cervicovaginal β/γ–human papillomavirus (HPV) and their relationship to cervical precancer in women with human immunodeficiency virus; having previously reported strong positive associations of β/γ-HPV with incident head and neck cancer in the general population. Case patients (n = 124) had cervical intraepithelial neoplasia (CIN) 3 or 2. Controls (n = 247) were individually matched 2:1 to case patients. Unexpectedly, multivariate analyses found strong inverse associations between β/γ-HPV and CIN-2/3 (odds ratio, 0.19 [95% confidence interval, .04–.86]; P = .03; Ptrend < .01]). This is, to our knowledge, the first study of β/γ-HPV and cervical precancer. If confirmed, a strong inverse (protective) association would be of potential clinical and biologic relevance.

Sex and organ‐specific risk and temporal trends of human papillomavirus‐associated anogenital cancer among solid organ transplant recipients in the United States

Abstract Solid organ transplant recipients (SOTRs) have an elevated risk of persistent infection of human papillomavirus (HPV) and associated anogenital (cervical, vulva, and vaginal among women, penile among men and anal among both men and women) cancers. Risk stratification and temporal trends of cancer incidence will help early detection, evaluation, management, and treatment of post‐transplant cancers over time. We analyzed data of 239,613 heart, lung, liver, and kidney transplant recipients registered from 1987 to 2020 in the U.S. Scientific Registry of Transplant Recipients (SRTR) with cancer diagnosis reported during follow‐up. There were 693 new cases of HPV‐associated anogenital cancers, including 176 anal, 118 cervical, 310 vulvar, and 89 penile cancers. The age‐adjusted incidence rates and confidence intervals (IRs [95% CI] per 100,000 person‐years) were anal (10.5 [9.1, 12.2]), cervical (17 [14.2, 20.4]), vulvar (44.2 [39.5, 49.4]), and penile (9.0 [7.3, 11.1]). Overall, the risk of all cancers among SOTRs remains elevated compared with the U.S. general population: standardized incidence ratio (SIR) for anal (2.73 [2.34, 3.14]), cervical (1.46 [1.21, 1.73]), vulvar (8.82 [7.87, 9.83]), and penile (6.13 [3.38, 9.70]). Lung recipients showed the highest IR for anal, vulvar, and penile cancer, while heart recipients demonstrated the highest IR for cervical cancer. Similarly, the 10‐year cumulative incidence (per 100,000 persons) of anal (124), vulvar (523) and penile (95) cancer was highest among lung recipients, while the highest cumulative incidence of cervical cancer (231) was among heart recipients. These data can help develop risk stratification for HPV‐associated cancer screening and management among SOTRs.

Community-level Social Vulnerability and Cervical Cancer Mortality Among Young and Old Adults in the State of Alabama

Abstract In addition to individual factors, differences in community-level factors impact mortality rates of cervical cancer (CC), especially in the Southeast United States, where CC one-year mortality is significantly higher than national average. This study investigated the association between community-level social vulnerability measured using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) and overall and one-year CC mortality in Alabama. Retrospective cohort study using Alabama State Cancer Registry data from 2012 to 2021. Outcome of interest was mortality due to CC. Residential addresses were geocoded to determine SVI scores categorized into quartiles. Cox proportional hazards model was used to assess associations between SVI quartiles and overall and one-year CC mortality adjusting for age at diagnosis, race, marital status, and insurance status. Further, CC mortality in younger adults (≤50 years) was compared with older adults (> 50 years). A total of 1,325 women with CC were included in the study. The median age at diagnosis was 49 years (IQR: 39–62) and 69.73% were White. Median follow-up time was 9 months (IQR: 5–17). Among older adults, we observed statistically significant association between higher SVI quartiles and overall mortality (Q4: aHR 1.86; 95% CI 1.15, 3.01; p = 0.012] and one-year mortality (Q3: aHR 2.66; 95% CI 1.34, 5.29; p = 0.005; Q4: aHR 2.45; 95% CI 1.18, 5.08; p = 0.016). This study highlights the role of community factors in CC mortality among older women. Community-level strategies are needed to reduce the burden of CC mortality in Alabama and other high-risk regions.