Hormonal Contraceptives and the Length of Their Use Are Not Independent Risk Factors for High-Risk HPV Infections or High-Grade CIN

Abstract

Aims: To evaluate the role of hormonal contraceptives as a risk factor of high-risk human papillomavirus (HR-HPV), cervical intraepithelial lesions (CIN) and cervical cancer in our multi-center population-based LAMS (Latin American Screening) study. Methods: A cohort study with >12,000 women from Brazil and Argentina using logistic regression to analyze the covariates of hormonal contraception (HOC – oral, injections, patches, implants, vaginal ring and progesterone intrauterine system) use followed by multivariate modeling for predictors of HR-HPV and CIN2+. Results: HR-HPV infection was a consistent risk factor of high-grade CIN in all three groups of women. The length of HOC use was not significantly related to high-grade squamous intraepithelial lesions (HSIL)+ Pap (p = 0.069), LSIL+ Pap (p = 0.781) or ASCUS+ (p = 0.231). The same was true with the length of HOC use and histology CIN3+ (p = 0.115) and CIN2+ (p = 0.515). Frequently, HOC users have previously shown more HPV-related lesions, as well as lower HPV prevalence if they were current smokers. But HOC use and time of usage were not independent risk factors of either HR-HPV infection or high-grade CIN using multiple logistic regressions. Conclusions: No evidence was found for an association between the use of HOC with an increased risk for HR-HPV infection or high-grade CIN in this cohort.

A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya

“…In addition, being on a first-line regimen and having been on HAART for longer were associated with lower odds of having a positive VIA. Unlike the observed association between older age and lower rates of VIA positivity, for [24][25][26] Owing to confounding behavioural characteristics, the data obtained in this study allow no conclusion to be drawn about the relationship between screening test performance, CIN 2+ prevalence and the use of hormonal contraceptives.…”

Prevalência de infecção cervical por papilomavírus humano e neoplasia intraepitelial cervical em mulheres HIV-positivas e negativas

“…A infecção cervical pelo HPV é fator necessário, mas não suficiente, para o desenvolvimento do câncer de colo uterino. Além da infecção pelo HIV, outros fatores podem estar associados à etiologia desse tumor, tais como tabagismo, uso de contraceptivos orais, baixa ingestão de vitaminas, outras DSTs concomitantes, início precoce de atividade sexual, múltiplos parceiros sexuais, multiparidade e outros, além de aspectos relacionados à genética e à resposta imunológica do hospedeiro 6,7 . Metanálise de Smith et al 8 mostrou que a infecção cervical pelo HPV é mais frequente nas pacientes jovens, menores de 25 anos, sendo observado um segundo pico, em algumas regiões do mundo, entre 35 e 50 anos, relacionado à mudança no comportamento sexual dessas mulheres.…”

The Effect of Progesterone Only Contraception on the Accuracy of Cervical Cytologic interpretation

“…[76][77][78] The mechanism whereby exogenous combined contraceptive use may increase a woman's risk for cervical neoplasia is thought to be via binding of the steroid contraception to particular DNA sequences in the transcriptional areas of the HPV DNA.…”

“…76 The variables that were noted to be associated with an increased risk of developing CIN (HR; 95% CI) were LSIL cytology at baseline (1.99; 1.42 -2.80) and high risk HPV infection (4.17; 1.74 -9.96). Factors found to be unrelated to development of CIN were: 1) baseline HSIL cytology; 2) young age at coitarche; 3) age over 35 years; 4) ever having been pregnant; 5) number of births; 6) current smoking status; and 7) being single.…”

“…Longatto-Filho et al (2011) note that those studies in which a causal relationship is suggested should control for sexual behavior as well as high risk HPV infection. 76 Multiple reasons have been cited for the difference in findings regarding COC use and cervical neoplasia risk. These reasons include variable and poor research design, use of homogenous populations, the implication that women who use COCs have characteristically different sexual patterns, as well as external factors which independently increase the risk for cervical neoplasia.…”