Virus and Non-HIV-Associated Immunosuppression and Risk of Cervical Neoplasia.

OBJECTIVE: To estimate the risk of cervical intraepithelial neoplasia grade 2, 2–3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)– and non-HIV–associated immunosuppression. METHODS: We performed a case–control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n 5 100,144) enrolled in an integrated health care system from 1996 to 2014. Adjusted rate ratios (RRs) from conditional logistic regression were obtained for HIV status (stratified by CD4 + T-cells), solid organ transplant history, and immunosuppressive medication use. RESULTS: Risk of CIN 2 or worse was increased among women with HIV (n 5 36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3– 3.0) compared with those without HIV and in solid organ transplant recipients (n 5 51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3– 4.8) compared with women without a prior transplant. The highest risks were among women with HIV and less than 200 CD4 + T-cells/microliter (n 5 9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1–14.7) compared with those without HIV and in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n 5 32 women in the case group and

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