Incidence and Hazard of Cervical and Oropharyngeal Cancers in HIV-infected and HIV-uninfected Medicaid Beneficiaries

Michaud, Joanne Marie

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Year:: 2019
Contributor:: Michaud, Joanne Marie (creator); Wilson, Ira (Advisor); Kelsey, Karl (Reader); Brown University. School of Public Health (sponsor)
Genre:: theses
Subject:: Papillomaviruses; Cervix uteri--Cancer; HIV; Medicaid; Oropharyngeal cancer
Extent:: ix, 72 p.
DOI: https://doi.org/10.26300/kyfy-2m26

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Abstract:: Persistent infection with human papillomavirus (HPV) can lead to anogenital and oral cancers, especially of the cervix and oropharyngeal region. Coinfection with the human immunodeficiency virus (HIV) is a known risk factor for HPV-associated cancers, but measures of association can be confounded by other factors such as age, sex, race, state, year, chronic medical conditions, tobacco use, alcohol abuse, and exogenous hormone use. Previous studies on HIV infection and HPV-associated cancers vary in sample size, sample characteristics, comparison groups, time period, geographic location, and measured covariates, resulting in a wide range of published risk and incidence ratios. To derive minimally biased estimates of the relationship between HIV infection and incident cervical and oropharyngeal cancer, I conducted a retrospective cohort study using twelve years of U.S. Medicaid claims data for a large national sample of both HIV-infected and HIV-uninfected persons, matching on five demographic variables and further adjusting for demographic and comorbidity attributes. In adjusted Cox proportional hazards models, HIV+ women had 2.60 times the hazard of cervical cancer (95% CI 2.16 - 3.12; P<.0001) compared with HIV- women, and HIV+ persons had 1.75 times the hazard of oropharyngeal cancer (95% CI 1.41 - 2.16; P<.0001) compared with HIV- persons. Although men had a higher incidence rate of oropharyngeal cancer than women for both HIV groups, the hazard ratio was greater for women. In this population, after adjusting for covariates, the hazards of cervical and oropharyngeal cancers for HIV+ persons relative to HIV- persons are clinically relevant, although somewhat lower than previously published estimates reported as incidence ratios. Several covariates were significant in my model, including tobacco use for cervical cancer and alcohol abuse for oropharyngeal cancer. Steps to reduce the burden of HPV-associated cancers on HIV+ persons include prompt diagnosis of and treatment for HIV infection, routine Papanicolaou and cervical HPV DNA testing, development of biomarkers for detection of early stage oropharyngeal cancer, HPV vaccination for both females and males, and treatment for tobacco use and substance abuse disorders.
Notes:: Thesis (M. P. H.)--Brown University, 2019

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Michaud, Joanne Marie, "Incidence and Hazard of Cervical and Oropharyngeal Cancers in HIV-infected and HIV-uninfected Medicaid Beneficiaries" (2019). Public Health Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.26300/kyfy-2m26

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Public Health Theses and Dissertations

Theses and Dissertations for the Public Health department.
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