title: Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort.
abstract: Drug abuse (addiction) has been listed among the risk factors for human papillomavirus (HPV) infections, but no case-control studies exist to rule out sexual behaviour and other potential confounders. The aim of this study is to evaluate the role of drug addiction as an independent predictor of HR-HPV infections and (cervical intraepithelial neoplasia) CIN2+ in an age-matched case-control (1:4) study nested within the prospective Latin American Screening (LAMS) study cohort. All 109 women in the LAMS cohort (n=12,114) reporting drug abuse/addiction were matched with four controls (n = 436) of non-abusers strictly by age. Conditional logistic regression analysis was used to estimate the co-variates of drug abuse, and the whole series (n=545) was analysed for predictors of HR-HPV and CIN2+ using univariate and multivariate regression models. Oncogenic HPV infections were significantly (P=0.019) more prevalent among abusers (37.7%) than in controls (21.9%), but there was no difference in high-grade squamous intraepithelial lesions (P=0.180) or CIN2+ lesions (P=0.201). In multivariate conditional logistic regression, number of lifetime sexual partners (P=0.0001), ever smokers (P=0.0001), non-use of OCs (P=0.013), ever having sexually transmitted diseases (STD) (P=0.041) and no previous Pap smear (P=0.027) were independent co-variates of drug addiction. Drug abuse was not an independent risk factor of high-risk (HR)-HPV infection, which was significantly predicted by (1) age below 30 years (P=0.045), (2) more than five lifetime sexual partners (P=0.046) and (3) being current smoker (P=0.0001). In multivariate model, only HR-HPV infection was an independent risk factor of CIN2+ (P=0.031), with adjusted OR=11.33 (95% CI 1.25-102.50). These data indicate that drug addiction is not an independent risk factor of either HR-HPV infections or CIN2+, but the increased prevalence of HR-HPV infections is explained by the high-risk sexual behaviour and smoking habits of these women.
authors.affiliation: Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland. kari.syrjanen@tyks.fi
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
authors.forename: P
authors.initials: P
authors.lastname: Naud
authors.forename: S
authors.initials: S
authors.lastname: Derchain
authors.forename: C
authors.initials: C
authors.lastname: Roteli-Martins
authors.forename: A
authors.initials: A
authors.lastname: Longatto-Filho
authors.forename: S
authors.initials: S
authors.lastname: Tatti
authors.forename: M
authors.initials: M
authors.lastname: Branca
authors.forename: M
authors.initials: M
authors.lastname: Erzen
authors.forename: L S
authors.initials: LS
authors.lastname: Hammes
authors.forename: J
authors.initials: J
authors.lastname: Matos
authors.forename: R
authors.initials: R
authors.lastname: Gontijo
authors.forename: L
authors.initials: L
authors.lastname: Sarian
authors.forename: J
authors.initials: J
authors.lastname: Bragança
authors.forename: F C
authors.initials: FC
authors.lastname: Arlindo
authors.forename: M Y S
authors.initials: MY
authors.lastname: Maeda
authors.forename: A
authors.initials: A
authors.lastname: Lörincz
authors.forename: G B
authors.initials: GB
authors.lastname: Dores
authors.forename: S
authors.initials: S
authors.lastname: Costa
authors.forename: S
authors.initials: S
authors.lastname: Syrjänen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000150:complications*