The potential impact of cocaine-associated immune suppression on human papillomavirus-associated clinical outcomes

cocaine;human papillomavirus;squamous intraepithelial lesions;immune suppression;human immunodeficiency virus;Epidemiology

Tang, Tania Wai HanHoltgrave, David R. ;

Johns Hopkins University

关键词: cocaine;    human papillomavirus;    squamous intraepithelial lesions;    immune suppression;    human immunodeficiency virus;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/37191/TANG-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Cocaine use has been linked to an increased risk of human papillomavirus (HPV) infection and cervical cancer among women, as well as immune suppressive effects in laboratory and animal settings. We hypothesized that cocaine may impact immune control and reduce the host’s ability to suppress HPV replication. However, the role of cocaine use on immunity has not yet been examined in drug-using populations at high risk for HPV infection and cervical cancer. Understanding the natural history of HPV infection in the context of potential cocaine-associated immune suppression may influence clinical management of drug-using women at risk for cervical cancer. Using human immunodeficiency virus (HIV)-infected and at-risk uninfected Women’s Interagency HIV Study (WIHS) participants followed prospectively prior to the widespread use of highly active antiretroviral therapy (HAART), we found nearly half exhibited a diminished epithelial immune response detected using cutaneous anergy testing. We observed a positive association between cocaine use and epithelial immune suppression independent of other risk factors among HIV-uninfected women. In contrast, we were unable to detect a cocaine effect on this immune-mediated response among women with immune-suppressive HIV infection. We additionally examined the association between cocaine use and incident cervical abnormalities detected by Papanicolau (Pap) smear testing among current and former injection drug-using women in the AIDS Linked to the Intravenous Experience (ALIVE) study. Stratifying our analyses by HIV status, we observed a non-statistically significant increased risk of incident abnormalities among HIV-uninfected women who recently used cocaine. Similar to the cocaine-anergy analysis, we also found no association among HIV-infected women between cocaine use and abnormal Pap results. However, cervical abnormalities detected by Pap smear may reflect cellular changes not associated with risk of HPV-associated cervical cancer, warranting closer examination. We further examined the effect of cocaine use on HPV-specific cervical cytological abnormalities in a subset of women with HPV genotype data available, but were unable to detect statistically significant risk associations.Our findings among immune competent women indicate a potential association between cocaine use and dampened cell-mediated immunity at the epithelial cell level. Cocaine-mediated immune suppression may have direct implications for HPV-related risks of cervical abnormalities and cancer.