International Journal of STD & AIDS > Volume 19, Number 4 > Pp. 251-258

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Original research articles

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

K Syrjänen MD PhD ^* , P Naud MD PhD , S Derchain MD PhD , C Roteli-Martins MD PhD , A Longatto-Filho MSc PhD ^¶ #, S Tatti MD PhD ^**, M Branca MD PhD , M Eren MD PhD , L S Hammes MD PhD , J Matos MD , R Gontijo MD , L Sarian MD , J Bragança MD , F C Arlindo MD , M Y S Maeda MSc ^¶ #, A Lörincz MD PhD , G B Dores MD ^¶¶, S Costa MD PhD ^## and S Syrjänen DDS PhD ^***

^* Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland; Hospital de Clinicas de Porto Alegre; Universidade Estadual de Campinas, Campinas; Hospital Leonor M de Barros, Sao Paulo; ^¶ Instituto Adolfo Lutz, Sao Paulo, Brazil; ^# University of Minho, Braga, Portugal; ^** First Chair Gynecology Hospital de Clinicas, Buenos Aires, Argentina; Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy; SIZE Diagnostic Center, Ljubljana, Slovenia; Digene Corp., MD, USA; ^¶¶ Digene Brazil, Sao Paulo, Brazil; ^## Department of Obstetrics and Gynecology, S.Orsola-Malpighi Hospital, Bologna, Italy; ^*** Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland

Correspondence to: Prof Kari Syrjänen, Department of Oncology and Radiotherapy, Turku University Hospital, Savitehtaankatu 1, FIN 20521, Turku, Finland Email: kari.syrjanen{at}tyks.fi

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.

Key Words: drug abuse • addiction • case-control setting • risk factors • smoking • HR-HPV • CIN • cervical cancer • conditional logistic regression

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