Cervical neoplastic lesions in relation to CD4 T-lymphocyte counts and antiretroviral therapy in HIV-infected women in Yunnan, China

Authors: Zhang D, Chen W, Zhang H, Qiao Y, Braithwaite D

Category: Global Cancer Research
Conference Year: 2020

Abstract Body:
Purpose: China lacks data demonstrating associations of cervical neoplastic lesions with CD4 T-lymphocyte (CD4 cell) counts and antiretroviral therapy (ART) in HIV-infected women. We set out to examine their associations by using pooled data from 2 cross-sectional studies in China. Methods: A total of 545 HIV-infected women were enrolled at two cities (Mangshi and Kunming) in Yunnan, China, between 2011 and 2013. CD4 cell counts and current ART use were measured via medical records. Biopsy samples were collected from women with suspicious neoplastic lesions and pathological outcomes were interpreted by professional pathologists. Two multivariable logistic models, which treated cervical intraepithelial neoplasia (CIN) 1+ and CIN2+ as outcomes respectively, calculated adjusted odds ratio (aOR) of CD4 cell counts and ART. The model adjusted for age, ethnicity, education, site, income, marital status, smoking status, number of sexual partners, time elapsed since HIV diagnosis, and high-risk human papillomavirus infection. Subgroup analysis treating CIN1+ as the outcome was conducted by HIV infection (<4 vs. ≥4 years), ethnicity (Han vs. non-Han), and site (Mangshi vs. Kunming). Results: Prevalence of CIN1+ and CIN2+ was 17.4% and 7.3%, respectively. Overall, 243 (44.6%) women had CD4 cell counts≥500 cell/ µL, 187 (34.3%) used ART for<2 years, and 236 (43.3%) used ART for≥2 years. We found inverse associations of CIN1+ with CD4 cell counts (≥500 vs. <500 cells/µL: aOR=0.46, 95% CI=0.27-0.79) and ART use (<2 years vs. non-users: aOR=0.43, 95% CI=0.21-0.87; ≥2 years vs. non-users: aOR=0.54, 95% CI=0.27-1.10). Point estimates of CD4 cell counts and ART use did not change substantially when outcome in the model was CIN2+ but aORs of ART became non-significant. Ethnicity and study site potentially modified the effects of CD4 cell counts on CIN1+ (p-interaction<0.05). The effect measures of CD4 cell counts were much stronger for women of Han ethnicity or in Kunming. Conclusions: Our study suggests potential protective effects of high CD4 cell counts against cervical neoplastic lesions among HIV- infected women in China, whereas associations of ART are less consistent. Future studies with clear temporality are needed to verify our conclusion.

Keywords: cervical cancer prevention, HIV, global health, epidemiology