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Gillis N, Dickey BL, Colin-Leitzinger C, Tang YH, Putney RM, Mesa TE, Yoder SJ, Suneja G, Spivak AM, Patel AB, Extermann M, Giuliano AR, Teng M, Kresovich J, Berglund A, Coghill AE. Clonal hematopoiesis in patients with HIV and cancer. J Infect Dis 2024:jiae212. [PMID: 38657098 DOI: 10.1093/infdis/jiae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Cancer-related deaths for people living with HIV (PWH) are increasing due to longer life expectancies and disparately poor cancer-related outcomes. We hypothesize that advanced biological aging contributes to cancer-related morbidity and mortality for PWH and cancer. We sought to determine the impact of clonal hematopoiesis (CH) on cancer disparities in PWH. METHODS We conducted a retrospective study to compare the prevalence and clinical outcomes of CH in PWH and people without HIV (PWoH) and cancer. Included in the study were PWH and similar PWoH based on tumor site, age, tumor sequence, and cancer treatment status. Biological aging was also measured using epigenetic methylation clocks. RESULTS In 136 patients with cancer, PWH had twice the prevalence of CH compared to similar PWoH (23% vs 11%, p=0.07). After adjusting for patient characteristics, PWH were four-times more likely to have CH than PWoH (OR 4.1, 95% CI 1.3-13.9, p=0.02). The effect of CH on survival was most pronounced in PWH, who had a 5-year survival rate of 38% if they had CH (vs 59% if no CH), compared to PWoH who had a 5-year survival rate of 75% if they had CH (vs 83% if no CH). CONCLUSION This study provides the first evidence that PWH may have a higher prevalence of CH than PWoH with the same cancers. CH may be an independent biological aging risk factor contributing to inferior survival for PWH and cancer.
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Affiliation(s)
- Nancy Gillis
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Brittney L Dickey
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Yi-Han Tang
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ryan M Putney
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tania E Mesa
- Molecular Genomics Core Facility, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Sean J Yoder
- Molecular Genomics Core Facility, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Gita Suneja
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Adam M Spivak
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ami B Patel
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
- Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Martine Extermann
- Senior Adult Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Mingxiang Teng
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jacob Kresovich
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Breast Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anna E Coghill
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Dickey BL, Gore LR, Slebos R, Sirak B, Isaacs-Soriano KA, Kennedy K, Otto K, Wadsworth JT, Chung CH, Giuliano AR. A cross-sectional study of the association of dental health factors with progression and all-cause mortality in men diagnosed with HPV-associated oropharyngeal cancer. BMC Oral Health 2024; 24:433. [PMID: 38594660 PMCID: PMC11005190 DOI: 10.1186/s12903-024-04047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Human Papillomavirus-associated oropharyngeal cancer (HPV-OPC) incidence is increasing among men in the United States. Poor dental health has previously been associated with risk of head and neck cancers, oral HPV infection, and persistence but it is not understood whether dental health is associated with outcomes. We sought to determine the association of dental health with progression free survival and overall mortality among men with an HPV-OPC. METHODS A cross sectional study of men diagnosed with HPV-OPC between 2014-2020 at Moffitt Cancer Center in Tampa, FL was conducted. Dental records were abstracted for assessment of dental fitness prior to cancer treatment. Five dental factors including number of teeth lost, pocket depth, gingival score, loss of attachment, and bone loss were individually examined. Risk factor and outcome data were collected from a patient risk questionnaire and medical record. Using item response theory, an overall dental fitness score from five dental factors was developed in which missing data were multiply imputed. Cox proportional hazards model was used to assess whether dental factors were associated with progression-free survival or overall mortality. RESULTS Among 206 HPV-OPC cases, median follow-up was 3.4 years (IQR: 2.4-4.4) during which 40 cases involved progression or mortality and 25 deaths occurred. Overall dentition was significantly associated with progression free survival (p = 0.04) and with overall survival (p = 0.03) though findings were not significant after adjustment for age at diagnosis, stage, and smoking history (p = 0.146 and p = 0.120, respectively). A pocket depth of 7 mm or more was associated with overall survival (HR: 5.21; 95% CI: 1.43-19.11) and this remained significant after adjustment for confounding (aHR: 4.14; 95% CI: 1.72-16.26). CONCLUSIONS Among men diagnosed with an HPV-associated OPC in the US, worse dental health was associated with reduced progression free survival and overall survival, but not after adjustment for confounders. Further studies are needed to examine whether dental health is associated with other prognostic factors and subsequent treatment-related outcomes.
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Affiliation(s)
- Brittney L Dickey
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - L Robert Gore
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Robbert Slebos
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kimberly A Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kristen Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - J Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Dickey BL, Putney RM, Schell MJ, Berglund AE, Amelio AL, Caudell JJ, Chung CH, Giuliano AR. Identification of a Biomarker Panel from Genome-Wide Methylation to Detect Early HPV-Associated Oropharyngeal Cancer. Cancer Prev Res (Phila) 2024; 17:169-176. [PMID: 38286404 PMCID: PMC10987272 DOI: 10.1158/1940-6207.capr-23-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/05/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024]
Abstract
As oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) increases in men, the need for a screening test to diagnose OPC early is crucial. This study agnostically identified differentially methylated CpG sites to identify additional biomarkers to improve screening for early OPC.DNA was extracted from oral gargles of 89 early cases and 108 frequency matched healthy controls, and processed for genome-wide methylation using the Illumina Infinium MethylationEPIC BeadChip. Selected sites were combined with our prior methylation data in the EPB41L3 gene (CpG sites 438, 427, and 425) and oral HPV16 and HPV18 status were considered as binary variables (positive/negative). Lasso regression identified CpG sites strongly associated with early OPC. ROC curves with AUC were generated. The panel was validated utilizing bootstrap resampling.Machine learning analyses identified 14 markers that are significantly associated with early OPC, including one EPB41L3 CpG site (438) and oral HPV16 status. A final model was trained on all available samples using the discovered panel and was able to predict early OPC compared with controls with an AUC of 0.970 on the training set. In the bootstrap validation sets, the average AUC was 0.935, indicating adequate internal validity.Our data suggest that this panel can detect OPC early, however external validation of this panel is needed. Further refinement of a panel of biomarkers to diagnose OPC earlier is urgently needed to prevent complex treatment of OPC and associated comorbidities, while reducing risk of recurrence. PREVENTION RELEVANCE This study identified biomarkers using genome-wide methylation to create a panel capable of discerning early oropharyngeal cancer (OPC) from those without OPC. Such a biomarker panel would be an effective tool to detect OPC early and prevent complications of treatment associated with later diagnosis.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida USA
| | - Ryan M Putney
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Michael J. Schell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anders E. Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Antonio L. Amelio
- Department of Tumor Biology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jimmy J. Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anna R. Giuliano
- Center for Immunization and infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida USA
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Concordance of Human Papillomavirus Genotypes in Mailed Home-Based Self-Collected Versus Clinician-Collected Anal Swabs Among Sexual and Gender Minority Individuals. Sex Transm Dis 2024; 51:270-275. [PMID: 38133570 PMCID: PMC10978280 DOI: 10.1097/olq.0000000000001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Home-based self-sampling may be a viable option for anal cancer screening among sexual minority men (SMM). Yet limited research has compared home-based self-collected with clinician-collected anal swabs for human papillomavirus (HPV) genotyping. METHODS The Prevent Anal Cancer Self-Swab Study recruited SMM and transgender persons 25 years and over in Milwaukee, WI to participate in an anal cancer screening study. Participants were randomized to a home or clinic arm. Home-based participants were mailed an anal self-sampling kit to complete and return via postal mail. They were also asked to attend a clinic appointment where a clinician collected an anal swab. Swabs were HPV-genotyped using the SPF 10 -LiPA 25 assay. We analyzed 79 paired self and clinician swabs to determine HPV prevalence, percent agreement, and sensitivity and specificity of the mailed home-based anal self-swab to detect HPV genotypes using the clinician-collected swab as the reference. RESULTS The median number of days between the home and clinic swab was 19 days (range = 2 to 70). Human papillomavirus was detected in 73.3% of self and 75.0% of clinician anal swabs ( P = 0.99). Prevalence of any HPV, any high-risk HPV, any low-risk HPV, and individual HPV types did not significantly differ between self and clinician anal swabs. Agreement between self and clinician swabs was over 90% for 21 of the 25 HPV genotypes. Mailed home-based self-collected swabs had a sensitivity of 94.1% (95% confidence interval, 82.9-99.0) for detection of high-risk HPV versus clinician-collected sampling. CONCLUSIONS Mailed home-based self-collected and clinician-collected anal swabs demonstrated high concordance for HPV genotyping.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Dube Mandishora RS, Galati L, Reich RR, Combes JD, McKay-Chopin S, Makunike-Mutasa R, Masanganise R, Gwambiwa B, Magombei T, Zito FA, Lagiou P, Clifford GM, Giuliano AR, Coghill AE, Tommasino M, Gheit T. Epstein-Barr Virus DNA Is Associated With Conjunctival Squamous Cell Carcinomas: A Case-Control Study From Zimbabwe. Open Forum Infect Dis 2024; 11:ofae165. [PMID: 38623569 PMCID: PMC11017324 DOI: 10.1093/ofid/ofae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
Incidence of conjunctival squamous cell carcinoma (cSCC) in Zimbabwe is >30-fold higher than the global average. cSCC risk is notably higher among people with human immunodeficiency virus, implicating impaired immune response and a yet unknown infectious etiology. Formalin-fixed, paraffin-embedded blocks from Zimbabwe, comprising conjunctival precancer (n = 78), invasive cSCC cases (n = 148) and nonmalignant eye lesions (n = 119), were tested for multiple DNA viruses using Luminex bead-based technology. Epstein-Barr virus (EBV) type 1 positivity was strongly associated with cSCC diagnosis (adjusted odds ratio [aOR], 5.6 [95% confidence interval {CI}, 3.0-10.4) and marginally associated with precancer (aOR, 2.1 [95% CI, 1.0-4.5]). On analyzing EBV transcriptional activity with any of LMP1, EBNA1, and BZLF1, RNA transcripts were detected in 5 of 112 controls, 3 of 67 precancers, and 10 of 139 cases and none were associated with conjunctival case status. Our EBV DNA data suggest that EBV may play a role in cSCC. However, the low detection rate of EBV RNA supports further investigation to infer causality.
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Affiliation(s)
- Racheal S Dube Mandishora
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Medical Microbiology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Luisa Galati
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard R Reich
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Sandrine McKay-Chopin
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Rudo Makunike-Mutasa
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Rangarirai Masanganise
- Ophthalmology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Bevele Gwambiwa
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Tricia Magombei
- Medical Microbiology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Francesco Alfredo Zito
- Pathology Department, Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
| | - Pagona Lagiou
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gary M Clifford
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anna E Coghill
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Massimo Tommasino
- Pathology Department, Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
| | - Tarik Gheit
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
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Giuliano AR, Palefsky JM, Goldstone SE, Dubin B, Saah A, Luxembourg A, Velicer C, Tota JE. High Risk of New HPV Infection Acquisition Among Unvaccinated Young Men. J Infect Dis 2024; 229:707-718. [PMID: 38012959 PMCID: PMC10938197 DOI: 10.1093/infdis/jiad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND International data on anogenital HPV infection incidence among men are limited. METHODS Incidence of incident-persistent (IP) anogenital HPV infections was evaluated among 295 men who have sex with men (MSM) and 1576 heterosexual men (HM) aged 16-27 years in the placebo arm of a global, multicenter 4-valent (4v) HPV vaccine trial. We estimated IP incidence (penile/scrotal, perineal/perianal, anal) for 4vHPV and 9-valent (9v) HPV vaccine types and cumulative IP incidence over 36 months. RESULTS IP infection incidence per 100 person-years (95% CI) among HM for 4vHPV and 9vHPV types was 4.1 (3.5-4.9) and 6.8 (5.9-7.6) at penile/scrotal, and 1.2 (.8-1.6) and 1.9 (1.5-2.4) at perineal/perianal sites, respectively; and among MSM, IP infection incidence was 2.3 (1.3-3.8) and 3.2 (2.0-4.9) at penile/scrotal, 6.8 (4.9-9.2) and 9.0 (6.9-11.6) at perineal/perianal, and 12.0 (9.4-15.1) and 16.8 (13.7-20.2) at anal sites, respectively. Cumulative IP incidence over 36 months (excluding anal canal; any 9vHPV type) was higher among MSM versus HM (24.1% vs 18.4%). CONCLUSIONS A substantial proportion of unvaccinated men of catch-up vaccination age developed IP 9vHPV-related infections. Gender-neutral vaccination could decrease male HPV infection, contribute to herd protection, and reduce disease burden. Clinical Trials Registration. NCT00090285.
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Affiliation(s)
- Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Joel M Palefsky
- University of California SanFrancisco, San Francisco, California, USA
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Sonawane K, Zhu Y, Damgacioglu H, Garg A, Graboyes EM, Montealegre JR, Brownstein NC, Ford ME, Roberts JR, Sterba KR, Giuliano AR, Deshmukh AA. Factors associated with parental human papillomavirus vaccination intentions among adolescents from socioeconomically advantaged versus deprived households: a nationwide, cross-sectional survey. Lancet Reg Health Am 2024; 31:100694. [PMID: 38500960 PMCID: PMC10945422 DOI: 10.1016/j.lana.2024.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 03/20/2024]
Abstract
Background In the USA, HPV vaccine coverage is substantially lower among adolescents from high-income households compared to their low-income counterparts. We examined and compared the factors associated with parental HPV vaccination intentions between socioeconomically divergent groups. Methods Data from unvaccinated and not fully HPV-vaccinated adolescents from the 2017-2021 National Immunization Survey (NIS)-Teen were analyzed. Socioeconomically advantaged vs. deprived groups were identified based on dichotomized income (material capital) and education (social capital). Parental intent to initiate and complete the HPV vaccine series was compared using bivariable analysis and the factors associated with lacking intent were identified. Findings The 2017-2021 NIS-Teen included a total of 212,643 participants; the final analytical sample consisted of 105,958 adolescents (an estimated 10.3 million adolescents) who were unvaccinated or not fully vaccinated. In the advantaged group, 64.7% of parents of unvaccinated adolescents (equating to 2.4 million US adolescents) had no intention to initiate the HPV vaccine compared to 40.9% of parents in the deprived group (equating to 0.2 million adolescents) (P < 0.0001; S > 13.29). The most frequent reason for lacking intent in the advantaged group was 'safety concerns' (25.5%). In the deprived group, 'lack of knowledge', 'not recommended', and 'not needed' were common reasons (nearly 15% each). Lack of intent to complete the HPV vaccine series was higher in the advantaged group (43.9%; 1.1 million adolescents) compared to the deprived group (25.2%; 0.08 million adolescents) (P < 0.0001; S > 13.29). More than half in the advantaged group (58.4%) and over a third (37.1%) in the deprived group cited 'already up to date' as the main reason for not completing the HPV vaccine series. Interpretation Lack of intent to initiate and complete the HPV vaccination series, particularly among socioeconomically advantaged parents is a significant barrier to achieving the national goal in the USA. Funding The US National Institute on Minority Health and Health Disparities, the National Center for Advancing Translational Sciences, MUSC Hollings Cancer Center Seed funding, and the US National Cancer Institutes.
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Affiliation(s)
- Kalyani Sonawane
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Yenan Zhu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Haluk Damgacioglu
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Ashvita Garg
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Evan M. Graboyes
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | | | - Naomi C. Brownstein
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E. Ford
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - James R. Roberts
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- MUSC Hollings Cancer Center, Charleston, SC, USA
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Laily A, Duncan R, Gabhart KM, Nephew LD, Christy SM, Vadaparampil ST, Giuliano AR, Kasting ML. Differences in Provider Hepatitis C Virus Screening Recommendations by Patient Risk Status. Prev Med Rep 2024; 38:102602. [PMID: 38375175 PMCID: PMC10874862 DOI: 10.1016/j.pmedr.2024.102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
Providers' recommendation is among the strongest predictors to patients engaging in preventive care. Therefore, the aim of this study was to compare providers' Hepatitis C Virus (HCV) screening recommendation quality between high-risk and average-risk patients to determine if providers are universally recommending HCV screening, regardless of risk behaviors. This cross-sectional survey of 284 Indiana providers in 2020 assessed provider characteristics, HCV screening recommendation practices (strength, presentation, frequency, timeliness), self-efficacy, and barriers to recommending HCV screening. T-test and Chi-square compared recommendation practices for high-risk and average-risk patients. Prevalence ratios were calculated for variables associated with HCV recommendation strength comparing high-risk and average-risk patients. Logistic regression analyses examined factors associated with HCV recommendation strength for high- and average-risk patients, with odds ratios. Compared to average-risk patients, high-risk patients received higher proportion of HCV recommendations that were strong (70.4 % v. 42.4 %), routine (61.9 % v. 55.6 %), frequent (37.7 % v. 28 %), and timely (74.2 % v. 54.9 %) (P-values < 0.001). Compared to average-risk patients, providers with high-risk patients had a lower percentage of giving a strong recommendation if they were nurse practitioner (PR = 0.49). For high-risk patients, providers with higher self-efficacy (aOR = 2.16;95 %CI = 0.99-4.69) had higher odds, while those with higher perceived barriers (aOR = 0.19;95 %CI = 0.09-0.39) and those with an internal medicine specialty compared to family medicine (aOR = 0.22;95 %CI = 0.08-0.57) had lower odds of giving a strong recommendation. These data suggest providers are not universally recommending HCV screening for all adults regardless of reported risk. Future research should translate these findings into multilevel interventions to improve HCV screening recommendations regardless of patient risk status.
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Affiliation(s)
- Alfu Laily
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
| | - Robert Duncan
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, 1202 West State St., West Lafayette, IN 47907, USA
| | - Kaitlyn M. Gabhart
- Department of Psychology, Vanderbilt University, 230 Appleton Pl, Nashville, TN 37203, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, 535 Barnhill Dr., Indianapolis, IN 46202, USA
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Nitkowski J, Fernandez ME, Ridolfi T, Chiao E, Giuliano AR, Schick V, Swartz MD, Smith JS, Nyitray AG. The impact of body mass index and physical disability on home-based anal self-sampling. Cancer Causes Control 2024; 35:161-166. [PMID: 37632577 DOI: 10.1007/s10552-023-01775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. METHODS We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n = 120) or clinic (n = 120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilized data from participants who used the at-home kit and completed a baseline clinic visit and post-swab survey (n = 82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. RESULTS Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR = 1.10, 95% CI 1.003-1.20, p = 0.04) and swab positioning (aOR = 1.11, 95% CI 1.02-1.20, p = 0.01). Although not significant, participants who said body positioning was difficult had 2.79 higher odds of having a physical disability. Specimen adequacy did not differ by BMI category (p = 0.76) or physical disability (p = 0.88). CONCLUSION Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.
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Affiliation(s)
- Jenna Nitkowski
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Tim Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan G Nyitray
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Avenue, Milwaukee, WI, 53202, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Nitkowski J, Giuliano AR, Ridolfi T, Chiao E, Fernandez ME, Schick V, Swartz MD, Smith JS, Nyitray AG. Acceptability of Anal Human Papillomavirus Home Self-Sampling and Clinician Sampling Among Sexual and Gender Minority Individuals in Milwaukee, Wisconsin: The Prevent Anal Cancer Self-Swab Study. LGBT Health 2024; 11:47-56. [PMID: 37870947 DOI: 10.1089/lgbt.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
Purpose: Anal cancer has disproportionately high incidence among sexual minority men. We compared acceptability of home versus clinic human papillomavirus (HPV) anal swabbing. Methods: The Prevent Anal Cancer Self-Swab Study recruited sexual and gender minority individuals in Milwaukee, Wisconsin. Eligible participants were randomized to a home or clinic arm. Home participants received a mailed anal HPV self-sampling kit. Clinic participants attended a clinic appointment where a clinician collected an anal HPV swab. We examined acceptability (overall thoughts, comfort with method, pain, and future willingness to swab) of home versus clinic swabbing using postswab survey responses. Results: A total of 191 individuals completed swabbing and a postswab survey (home = 53.4%, clinic = 46.6%). Mean age was 47 years (range = 25-78). Reported overall thoughts about home (71.6%) and clinic (69.7%) swabbing were mostly positive (p = 0.83). Overall thoughts about the home kit did not differ by participant characteristics, but overall thoughts about clinician swabbing differed by race (p = 0.04) and HIV status (p = 0.002). Nearly all participants (98.4%) reported they were comfortable receiving the kit or getting the swabbing in the clinic, reported little or no pain (98.4%), and reported willingness to undergo swabbing in the future (97.9%). After swabbing, clinic participants reported greater trust that swabbing can give accurate information about anal cancer risk (89.9%) than home participants (69.6%) (p < 0.001), and that swabbing will help them avoid anal cancer (clinic = 79.8%, home = 59.8%) (p = 0.01). Conclusion: Anal swabbing acceptability was high and did not differ between home and clinic. Participants reported high confidence and knowledge using the mailed anal self-sampling kit. Clinical Trial Registration number is NCT03489707.
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Affiliation(s)
- Jenna Nitkowski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tim Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Chiao
- MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Nitkowski J, Ridolfi TJ, Lundeen SJ, Giuliano AR, Chiao E, Fernandez ME, Schick V, Smith JS, Brzezinski B, Nyitray AG. The influence of home versus clinic anal human papillomavirus sampling on high-resolution anoscopy uptake in the Prevent Anal Cancer Self-Swab Study. medRxiv 2023:2023.12.27.23300457. [PMID: 38234718 PMCID: PMC10793519 DOI: 10.1101/2023.12.27.23300457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Anal cancer disproportionately affects men who have sex with men (MSM) living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Method MSM and trans persons 25 years and older were randomized to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA one year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results 62.8% of 196 participants who engaged in screening attended HRA. Although not significant ( p =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.44, 95% CI 1.11 - 1.87) and lower among participants preferring versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53 - 0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) ( p =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), ( p =0.04); however, no differences in attendance by race or HIV status were observed in the home arm. Conclusions HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.
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12
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Dukes CW, Potez M, Lancet J, Kuter BJ, Whiting J, Mo Q, Leav B, Wang H, Vanas JS, Cubitt CL, Isaacs-Soriano K, Kennedy K, Rathwell J, Diaz Cobo J, O’Nan W, Sirak B, Dong N, Tan E, Hwu P, Giuliano AR, Pilon-Thomas S. Neutralizing Antibody Response following a Third Dose of the mRNA-1273 Vaccine among Cancer Patients. Vaccines (Basel) 2023; 12:13. [PMID: 38250826 PMCID: PMC10818923 DOI: 10.3390/vaccines12010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer patients are at an increased risk of morbidity and mortality from SARS-CoV-2 infection and have a decreased immune response to vaccination. We conducted a study measuring both the neutralizing and total antibodies in cancer patients following a third dose of the mRNA-1273 COVID-19 vaccine. Immune responses were measured with an enzyme-linked immunosorbent assay (ELISA) and neutralization assays. Kruskal-Wallis tests were used to evaluate the association between patient characteristics and neutralization geometric mean titers (GMTs), and paired t-tests were used to compare the GMTs between different timepoints. Spearman correlation coefficients were calculated to determine the correlation between total antibody and neutralization GMTs. Among 238 adults diagnosed with cancer, a third dose of mRNA-1273 resulted in a 37-fold increase in neutralization GMT 28 days post-vaccination and maintained a 14.6-fold increase at 6 months. Patients with solid tumors or lymphoid cancer had the highest and lowest neutralization GMTs, respectively, at both 28 days and 6 months post-dose 3. While total antibody GMTs in lymphoid patients continued to increase, other cancer types showed decreases in titers between 28 days and 6 months post-dose 3. A strong correlation (p < 0.001) was found between total antibody and neutralization GMTs. The third dose of mRNA-1273 was able to elicit a robust neutralizing antibody response in cancer patients, which remained for 6 months after administration. Lymphoid cancer patients can benefit most from this third dose, as it was shown to continue to increase total antibody GMTs 6 months after vaccination.
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Affiliation(s)
- Christopher W. Dukes
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
| | - Marine Potez
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jeffrey Lancet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Barbara J. Kuter
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Qianxing Mo
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Brett Leav
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Haixing Wang
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Julie S. Vanas
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | | | - Kimberly Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Julian Diaz Cobo
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Wesley O’Nan
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Bradley Sirak
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ning Dong
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Elaine Tan
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA
| | - Patrick Hwu
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
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Ferreira MT, Mendoza López RV, Gonçalves MG, Ferreira S, Sirak B, Baggio ML, Lazcano-Ponce E, Nyitray AG, Giuliano AR, Villa LL, Sichero L. Human Papillomavirus 16 Lineage A Variants Associated With Persistent Genital Infections in Men: The HPV Infection in Men (HIM) Study. J Infect Dis 2023; 228:1748-1757. [PMID: 37279655 PMCID: PMC10733738 DOI: 10.1093/infdis/jiad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 non-A lineage variants have higher carcinogenic potential for cervical cancer. HPV-16 variants natural history among males is not established. We evaluated HPV-16 variants prevalence and persistence in the external genitalia of men enrolled in the prospective HPV Infection in Men (HIM) Study. METHODS The HIM Study included men from the United States, Brazil, and Mexico. HPV-16 variants were distinguished using polymerase chain reaction sequencing. The prevalence of HPV-16 variants was assessed, and associations with infection persistence were estimated. RESULTS We characterized the HPV-16 variants for 1700 genital swab samples from 753 men and 22 external genital lesions in 17 men. The prevalence of HPV-16 lineages differed by country and marital status (P < .001). Overall, 90.9% of participants harbored lineage A variants. The prevalence of non-A lineages was heterogenous among countries. HPV-16 lineage A variants were associated with a 2.69-fold increased risk of long-term persistent infections compared with non-A lineages. All high-grade penile intraepithelial neoplasia harbored lineage A variants and occurred in the context of long-term persistent infections with the same variants. CONCLUSIONS The prevalence and persistence of HPV-16 variants observed at the male external genitalia suggest differences in the natural history of these variants between men and women, which may be associated with intrinsic differences in the infected genital epithelia.
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Affiliation(s)
- Matthew Thomas Ferreira
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Rossana Veronica Mendoza López
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Milena Giulia Gonçalves
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
| | - Silvaneide Ferreira
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, and Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Maria Luizai Baggio
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Eduardo Lazcano-Ponce
- Center for Population Health Research, Instituto Nacional de Salud Pública, Instituto Mexicano del Seguro Social, Cuernavaca, Mexico
| | - Alan G Nyitray
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, and Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Luisa L Villa
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Laura Sichero
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Comprehensive Center for Precision Oncology, Universidade de Sao Paulo, São Paulo, Brazil
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Robertson SE, Yasukawa M, Marchion DC, Xiong Y, Naqvi SMH, Gheit T, Tommasino M, Wenham RM, Giuliano AR, Lancaster JM, Shahzad MMK. Prevalence of viral DNA in high-grade serous epithelial ovarian cancer and correlation with clinical outcomes. PLoS One 2023; 18:e0294448. [PMID: 38039311 PMCID: PMC10691703 DOI: 10.1371/journal.pone.0294448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Currently 11 infectious agents are classified as carcinogenic but the role of infectious agents on outcomes of epithelial ovarian cancer is largely unknown. OBJECTIVE To explore the association between infectious agents and ovarian cancer, we investigated the prevalence of viral DNA in primary ovarian cancer tumors and its association with clinical outcomes. METHODS Archived tumors from 98 patients diagnosed with high-grade serous epithelial ovarian cancer were collected between 1/1/1994 and 12/31/2010. After DNA extraction, Luminex technology was utilized to identify polymerase chain reaction-amplified viral DNA for 113 specific viruses. Demographic data and disease characteristics were summarized using descriptive statistics. We used logistic regression and Cox proportional hazards model to assess associations between tumor viral status and disease outcome and between tumor viral presence and overall survival (OS), respectively. RESULTS Forty-six cases (45.9%) contained at least one virus. Six highly prevalent viruses were associated with clinical outcomes and considered viruses of interest (VOI; Epstein-Barr virus 1, Merkel cell polyomavirus, human herpes virus 6b, and human papillomaviruses 4, 16, and 23). Factors independently associated with OS were presence of VOI (HR 4.11, P = 0.0001) and platinum sensitivity (HR 0.21, P<0.0001). Median OS was significantly decreased when tumors showed VOI versus not having these viruses (22 vs 44 months, P<0.0001). Women <70 year old with VOI in tumors had significantly lower median OS versus age-matched women without VOI (20 vs 57 months, P = 0.0006); however, among women ≥70 years old, there was no difference in OS by tumor virus status. CONCLUSIONS The presence of a VOI was significantly associated with a lower OS. These findings may have implications for clinical management of ovarian cancer but require additional studies.
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Affiliation(s)
- Sharon E. Robertson
- Department of Gynecology Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Maya Yasukawa
- Department of Gynecology Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Douglas C. Marchion
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Yin Xiong
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Syeda Mahrukh Hussnain Naqvi
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Tarik Gheit
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Massimo Tommasino
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Robert M. Wenham
- Department of Gynecology Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Anna R. Giuliano
- Risk Assessment, Detection and Intervention Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Johnathan M. Lancaster
- Department of Gynecology Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Mian M. K. Shahzad
- Department of Gynecology Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States of America
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Dickey BL, Putney RM, Suneja G, Kresovich JK, Spivak AM, Patel AB, Teng M, Extermann M, Giuliano AR, Gillis N, Berglund A, Coghill AE. Differences in epigenetic age by HIV status among patients with a non-AIDS defining cancer. AIDS 2023; 37:2049-2057. [PMID: 37467055 PMCID: PMC10538418 DOI: 10.1097/qad.0000000000003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE People with HIV (PWH) are living longer and experiencing higher numbers of non-AIDS-defining cancers (NADC). Epigenetic aging biomarkers have been linked to cancer risk, and cancer is now a leading cause of death in PWH, but these biomarkers have not been investigated in PWH and cancer. DESIGN In order to compare epigenetic age by HIV status, HIV-uninfected participants were matched to PWH by reported age, tumor site, tumor sequence number, and cancer treatment status. METHODS DNA from blood was assayed using Illumina MethylationEPIC BeadChip, and we estimated immune cell composition and aging from three epigenetic clocks: Horvath, GrimAge, and epiTOC2. Age acceleration by clock was computed as the residual from the expected value, calculated using linear regression, for each study participant. Comparisons across HIV status used the Wilcoxon rank sum test. Hazard ratios and 95% confidence intervals for the association between age acceleration and survival in PWH were estimated with Cox regression. RESULTS Among 65 NADC participants with HIV and 64 without, biological age from epiTOC2 ( P < 0.0001) and GrimAge ( P = 0.017) was significantly higher in PWH. Biological age acceleration was significantly higher in PWH using epiTOC2 ( P < 0.01) and GrimAge ( P < 0.0001), with the difference in GrimAge remaining statistically significant after adjustment for immune cell composition. Among PWH, GrimAge acceleration was significantly associated with increased risk of death (hazard ratio 1.11; 95% confidence interval (CI) 1.04-1.18). CONCLUSION We observed a higher epigenetic age in PWH with a NADC diagnosis compared with their HIV-uninfected counterparts, as well as a significant association between this accelerated biological aging and survival for patients diagnosed with a NADC.
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Affiliation(s)
| | - Ryan M Putney
- Biostatistics/Bioinformatics Division, Moffitt Cancer Center
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah
| | - Jacob K Kresovich
- Department of Cancer Epidemiology
- Department of Breast Oncology, Moffitt Cancer Center
| | - Adam M Spivak
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine
| | - Ami B Patel
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah
| | - Mingxiang Teng
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center & Research Institute
| | | | - Anna R Giuliano
- Department of Cancer Epidemiology
- Center for Immunization and Infection Research in Cancer
| | | | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center & Research Institute
| | - Anna E Coghill
- Department of Cancer Epidemiology
- Center for Immunization and Infection Research in Cancer
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Bruni L, Albero G, Rowley J, Alemany L, Arbyn M, Giuliano AR, Markowitz LE, Broutet N, Taylor M. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1345-e1362. [PMID: 37591583 PMCID: PMC10447222 DOI: 10.1016/s2214-109x(23)00305-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The epidemiology of human papillomavirus (HPV) in women has been well documented. Less is known about the epidemiology of HPV in men. We aim to provide updated global and regional pooled overall, type-specific, and age-specific prevalence estimates of genital HPV infection in men. METHODS We conducted a systematic review and meta-analysis to assess the prevalence of genital HPV infection in the general male population. We searched Embase, Ovid MEDLINE, and the Global Index Medicus for studies published between Jan 1, 1995, and June 1, 2022. Inclusion criteria were population-based surveys in men aged 15 years or older or HPV prevalence studies with a sample size of at least 50 men with no HPV-related pathology or known risk factors for HPV infection that collected samples from anogenital sites and used PCR or hybrid capture 2 techniques for HPV DNA detection. Exclusion criteria were studies conducted among populations at increased risk of HPV infection, exclusively conducted among circumcised men, and based on urine or semen samples. We screened identified reports and extracted summary-level data from those that were eligible. Data were extracted by two researchers independently and reviewed by a third, and discrepancies were resolved by consensus. We extracted only data on mucosal α-genus HPVs. Global and regional age-specific prevalences for any HPV, high-risk (HR)-HPV, and individual HPV types were estimated using random-effects models for meta-analysis and grouped by UN Sustainable Development Goals geographical classification. FINDINGS We identified 5685 publications from database searches, of which 65 studies (comprising 44 769 men) were included from 35 countries. The global pooled prevalence was 31% (95% CI 27-35) for any HPV and 21% (18-24) for HR-HPV. HPV-16 was the most prevalent HPV genotype (5%, 95% CI 4-7) followed by HPV-6 (4%, 3-5). HPV prevalence was high in young adults, reaching a maximum between the ages of 25 years and 29 years, and stabilised or slightly decreased thereafter. Pooled prevalence estimates were similar for the UN Sustainable Development Goal geographical regions of Europe and Northern America, Sub-Saharan Africa, Latin America and the Caribbean, and Australia and New Zealand (Oceania). The estimates for Eastern and South-Eastern Asia were half that of the other regions. INTERPRETATION Almost one in three men worldwide are infected with at least one genital HPV type and around one in five men are infected with one or more HR-HPV types. Our findings show that HPV prevalence is high in men over the age of 15 years and support that sexually active men, regardless of age, are an important reservoir of HPV genital infection. These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies to reduce HPV-related morbidity and mortality in men and ultimately achieve elimination of cervical cancer and other HPV-related diseases. FUNDING Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020. TRANSLATIONS For the Spanish and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain.
| | - Ginesa Albero
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Jane Rowley
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology-Belgian Cancer Centre, Sciensano, Belgium
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Melanie Taylor
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Giuliano AR, Felsher M, Waterboer T, Mirghani H, Mehanna H, Roberts C, Chen YT, Lynam M, Pedrós M, Sanchez E, Sirak B, Surati S, Alemany L, Morais E, Pavón MA. Oral Human Papillomavirus Prevalence and Genotyping Among a Healthy Adult Population in the US. JAMA Otolaryngol Head Neck Surg 2023; 149:783-795. [PMID: 37535349 PMCID: PMC10401396 DOI: 10.1001/jamaoto.2023.1573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Importance In the US, oropharyngeal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection, is the most frequent HPV-associated cancer, surpassing cervical cancer. However, little is known about oral HPV prevalence and genotype distribution in the general population. Objective To assess oral HPV prevalence and factors associated with HR and low-risk infection in a general US population. Design, Setting, and Participants PROGRESS (Prevalence of Oral HPV Infection, a Global Assessment) was a cross-sectional observational study conducted between November 2021 and March 2022 in 43 dental offices in the US (24 urban, 13 urban cluster, and 6 rural sites), spanning 21 states. Eligible participants were aged 18 to 60 years, visiting dental clinics for routine dental examination. Dental clinics used targeted sampling to recruit equal distributions of men and women and across age groups. Exposure Participants provided an oral gargle specimen for HPV DNA and genotyping and completed behavioral questionnaires, and dentists reported oral health status. Detection of HPV DNA and genotyping was performed using the SPF10/DEIA/LiPA25 system at a central laboratory. Main Outcome Oral HPV prevalence. Results Of the 3196 participants enrolled, mean (SD) age was 39.6 (12.1) years, and 55.5% were women. Oral HPV prevalence was 6.6% (95% CI, 5.7%-7.4%) for any HPV genotype, and 2.0% (95% CI, 1.5%-2.5%), 0.7% (95% CI, 0.4%-1.0%), and 1.5% (95% CI, 1.1%-1.9%) for HR, HPV-16, and 9-valent-HPV vaccine types, respectively. Among HPV-positive participants, HPV-16 was the most prevalent genotype (12.4% among men and 8.6% among women). Prevalence of HPV was higher in men than women and highest among men aged 51 to 60 years (16.8%, 6.8%, and 2.1% for any HPV, HR HPV, and HPV-16, respectively). Factors associated with HR oral infection included being male (adjusted odds ratio [AOR], 3.1; 95% CI, 1.2-8.5), being aged 51 to 60 years (AOR, 3.3; 95% CI, 1.5-7.3), having 26 or more lifetime male sex partners (AOR, 6.5; 95% CI, 2.3-18.7), and having 6 to 25 lifetime female oral sex partners (AOR, 3.4; 95% CI, 1.3-8.7). Conclusions and Relevance In this cross-sectional study, oral HPV burden was highest among older men who may be at higher risk of developing oropharyngeal cancer. In addition to male sex and older age, HR oral HPV infection was also associated with sexual behaviors, including increasing number of male sex partners and female oral sex partners.
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Affiliation(s)
- Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marisa Felsher
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey
| | - Tim Waterboer
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Haïtham Mirghani
- Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Hisham Mehanna
- Institute of Head & Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, England
| | - Craig Roberts
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey
| | - Ya-Ting Chen
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey
| | | | | | | | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Shikha Surati
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey
| | - Laia Alemany
- Unit of Molecular Epidemiology and Genetics (UNIC EMG), Cancer Epidemiology Research Program, Catalan Institute of Oncology, ICO, L’Hospitalet, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Miquel Angel Pavón
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Laboratory Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, ICO, L’Hospitalet, Barcelona, Spain
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18
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Carnalla M, Rojas-Martínez R, Barrientos-Gutiérrez T, Allen-Leigh B, León-Maldonado L, Gutiérrez-Xicoténcatl L, Portillo-Romero AJ, Nyitray AG, Salmerón J, Giuliano AR, Lazcano-Ponce E. Prevalence and development of a risk score for oral human papillomavirus infection in men who have sex with men in Mexico. J Oral Pathol Med 2023; 52:751-757. [PMID: 37525481 DOI: 10.1111/jop.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/23/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk for oral human papillomavirus (HPV infection). There are no specific screening guidelines to facilitate the identification of people at risk for oral HPV infection. We aimed to estimate the prevalence of oral high-risk HPV and create a risk score to identify MSM at higher risk for prevalent oral HPV. METHODS We collected baseline data from a clinical trial from a subsample of 500 MSM attending sexually transmitted disease treatment clinics; they provided an oral gargle sample for high-risk HPV detection. We calculated oral high-risk HPV prevalence and 95% confidence intervals (CIs), used a logistic regression model to identify factors associated with high-risk HPV infection, and created a risk score. RESULTS The prevalence of any oral high-risk HPV among MSM was 11.1% (95% CI: 8.6-14.2), with a higher prevalence observed among men living with HIV (14.8%). Factors independently associated with oral high-risk HPV were age ≥40 years (OR = 2.71, 95% CI: 1.28-5.73 compared to <40 years), being HIV-positive with CD4 count 200-499 (OR = 2.76, 95% CI: 1.34-5.65 compared to HIV-negative), and recent recreational use of vasodilators (poppers/sildenafil) (OR = 2.02, 95% CI: 1.02-2.97). The risk score had good discriminatory power (AUC = 0.70, 95% CI: 0.63-0.77). CONCLUSIONS MSM have specific predictors for prevalent oral high-risk HPV, and a risk score could be used by clinicians to target men with vaccine recommendations and counseling, and identify those who could benefit from primary interventions given the available resources, or for referral to dental services for follow-up when available.
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Affiliation(s)
- Martha Carnalla
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Rosalba Rojas-Martínez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Leith León-Maldonado
- Centro de Investigación en Salud Poblacional, National Institute of Public Health, Cuernavaca, Mexico
| | - Lourdes Gutiérrez-Xicoténcatl
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | | | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
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Dukes CW, Rossetti RAM, Hensel JA, Snedal S, Cubitt CL, Schell MJ, Abrahamsen M, Isaacs-Soriano K, Kennedy K, Mangual LN, Whiting J, Martinez-Brockhus V, Islam JY, Rathwell J, Beatty M, Hall AM, Abate-Daga D, Giuliano AR, Pilon-Thomas S. SARS-CoV-2 antibody response duration and neutralization following natural infection. J Clin Virol Plus 2023; 3:100158. [PMID: 37654784 PMCID: PMC10470471 DOI: 10.1016/j.jcvp.2023.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background The role of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) neutralizing antibody response from natural infection and vaccination, and the potential determinants of this response are poorly understood. Characterizing this antibody response and the factors associated with neutralization can help inform future prevention efforts and improve clinical outcomes in those infected. Objectives The goals of this study were to prospectively evaluate SARS-CoV-2 antibody levels and the neutralizing antibody responses among naturally infected adults and to determine demographic and behavioral factors independently associated with these responses. Methods Serum was collected from seropositive individuals at baseline, four-weeks, and three-months following their first study visit to be evaluated for antibody levels. Detection of neutralizing antibodies was performed at baseline. Participant demographic and behavioral information was collected via web questionnaire prior to their first visit. Results At baseline, higher antibody levels were associated with better neutralization capacity, with 83% of participants having detectable neutralizing antibodies. We found an age-dependent effect on antibody level and neutralization capacity with participants over 65 years having significantly higher levels. Ethnicity, heart disease, autoimmune disease, and COVID symptoms were associated with higher antibody levels, but not with increased neutralization capacity. Work environment during the pandemic correlated with increased neutralization capacity, while kidney or liver disease and traveling out of state after February 2020 correlated with decreased neutralization capacity, however neither correlated with antibody levels. Conclusions Our data show that natural infection by SARS-CoV-2 can induce a humoral response reflected by high antibody levels and neutralization capacity.
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Affiliation(s)
- Christopher W Dukes
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Renata AM Rossetti
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Jonathan A Hensel
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Sebastian Snedal
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Christopher L Cubitt
- Immune Monitoring Core Facility, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Michael J Schell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Martha Abrahamsen
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Kimberly Isaacs-Soriano
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Kayoko Kennedy
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Leslie N Mangual
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Veronica Martinez-Brockhus
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Jessica Y Islam
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Matthew Beatty
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Amy M Hall
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Daniel Abate-Daga
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
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Islam JY, Bettampadi D, Reich RR, Nedjai B, Giuliano AR. Associations of HPV-16 Gene Methylation With Oral HPV-16 Persistence Among a Multinational Sample of Men. Sex Transm Dis 2023; 50:455-457. [PMID: 36943783 DOI: 10.1097/olq.0000000000001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Using data from the Human Papillomavirus (HPV) Infection in Men cohort study, we demonstrate HPV-16 methylation associations with persistent oral HPV infection, the obligate precursor to oropharyngeal cancer. Human papillomavirus type 16 persistence was significantly associated with methylation of HPV-16 L2 CpG-4268 (Wilcoxon P = 0.04), and methylation of HPV-16 E2 CpG Pos 4 (Wilcoxon P = 0.04).
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Affiliation(s)
- Jessica Y Islam
- From the Center for Immunization and Infection Research in Cancer, Cancer Epidemiology Program
| | - Deepti Bettampadi
- From the Center for Immunization and Infection Research in Cancer, Cancer Epidemiology Program
| | - Richard R Reich
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Belinda Nedjai
- Center for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Anna R Giuliano
- From the Center for Immunization and Infection Research in Cancer, Cancer Epidemiology Program
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21
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Nyitray AG, Ridolfi TJ, Nitkowski J, McAuliffe TL, Deshmukh AA, Giuliano AR, Chiao EY. Digital Anal Rectal Examination Usage Among Individuals at Increased Risk for Anal Cancer. J Low Genit Tract Dis 2023; 27:242-247. [PMID: 36961479 PMCID: PMC10313742 DOI: 10.1097/lgt.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Multiple organizations recommend an annual digital anal rectal examination (DARE) for people at highest risk for anal cancer. The authors assessed DARE usage among sexual minority men and transgender women. METHODS Community-recruited and asymptomatic individuals from a mid-sized US city were enrolled into the Prevent Anal Cancer Self-Swab Study, a longitudinal clinical trial of anal cancer screening. Self-reported data from the baseline survey were used to assess usage of DARE in the last year and during the lifetime. Adjusted odds ratios (aORs) and CIs for factors associated with each outcome were determined using multivariable logistic regression. RESULTS Among 241 participants, median age was 46 years (interquartile range, 33-57 years), 27.0% were living with HIV, and 24.5% reported a previous diagnosis of anal warts. A total of 13.7% (95% CI = 9.4%-18.0%) of individuals reported a DARE in the previous year, whereas 53.9% (95% CI = 47.7%-60.2%) reported a DARE during the lifetime. The following were associated with a DARE in the previous year: increasing age (aOR = 1.04; 95% CI = 1.01-1.08 for each additional year), any previous anal cytology (aOR = 2.62; 95% CI = 1.19-5.80, compared with no previous test or no knowledge of a test), and preferred receptive position during anal sex (aOR = 4.93; 95% CI = 1.17-20.86 compared with insertive). CONCLUSIONS Despite guidelines recommending an annual DARE, it was uncommonly reported. There is an urgent need to understand barriers to conducting DARE among individuals most vulnerable to anal cancer and their health care providers.
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Affiliation(s)
- Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | | | - Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, USA
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Rivera Rivera J, Fuzzell LN, Garcia J, Rathwell J, Robinson EJ, Chavez M, Fulton H, Whitmer A, Mathew E, Giuliano AR, Vadaparampil ST. Development of a Patient Activation Toolkit for Hepatitis C Virus Testing. J Cancer Educ 2023; 38:931-939. [PMID: 35971055 PMCID: PMC10187067 DOI: 10.1007/s13187-022-02209-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 05/18/2023]
Abstract
We evaluated the acceptability of a patient activation toolkit for hepatitis C virus (HCV) testing amidst universal adult guidelines. We developed a patient-facing toolkit that included a letter to the patient from their healthcare provider, HCV factsheet, and question prompt list, which contained questions for their provider about HCV infection and testing. We conducted qualitative interviews with patients ages 18-78 (n = 17), using a semi-structured interview guide based on learner verification. We assessed attraction, comprehension, cultural-linguistic acceptability, self-efficacy, and persuasiveness of toolkit materials using direct content analysis. Participants reported materials were attractive, offering suggestions to improve readability. They reported some understanding of materials but requested use of less medical jargon, particularly for the factsheet. Participants discussed cultural acceptability and suggested ways to improve language inclusiveness and comfort with content, given stigma surrounding HCV risk factors. Participants reported that including a letter, factsheet, and QPL improved the persuasiveness of materials, and they conveyed their motivation to be tested for HCV. Results indicate preliminary acceptability for use of the patient activation toolkit, which will be refined based on participants' recommendations. Overall, this patient activation toolkit holds promise for increasing HCV testing rates.
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Affiliation(s)
- Jessica Rivera Rivera
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA.
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Jennifer Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Julie Rathwell
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Edmondo J Robinson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Digital Health, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Melody Chavez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Hayden Fulton
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Ashley Whitmer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Ebin Mathew
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA.
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Nyitray AG, Nitkowski J, McAuliffe TL, Brzezinski B, Swartz MD, Fernandez ME, Deshmukh AA, Ridolfi TJ, Lundeen SJ, Cockerham L, Wenten D, Petroll A, Hilgeman B, Smith JS, Chiao EY, Giuliano AR, Schick V. Home-based self-sampling vs clinician sampling for anal precancer screening: The Prevent Anal Cancer Self-Swab Study. Int J Cancer 2023. [PMID: 37158105 DOI: 10.1002/ijc.34553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self-collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home-based self-collection swabbing kit or attend a clinic-based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home-arm and clinic-arm individuals returned the swab, respectively (P = .003), difference between groups, 15.0% (95% CI 5.4%-24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P = .006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P < .001). Self-collected swabs and clinician-collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self-collect swabs at home rather than attend a clinic.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - María E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah J Lundeen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Dave Wenten
- Holton Street Clinic, Milwaukee, Wisconsin, USA
| | - Andrew Petroll
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian Hilgeman
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
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24
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Luckett R, Feldman S, Woo YL, Moscicki AB, Giuliano AR, de Sanjose S, Kaufman AM, Leung SOA, Garcia F, Chan K, Bhatla N, Stanley M, Brotherton J, Palefsky J, Garland S. Point of View: COVID-19 as a catalyst for reimagining cervical cancer prevention. eLife 2023; 12:86266. [PMID: 37070731 PMCID: PMC10171861 DOI: 10.7554/elife.86266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.
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Affiliation(s)
| | | | | | | | - Anna R Giuliano
- H Lee Moffitt Cancer Center and Research Institute, Tampa, United States
| | | | | | | | | | - Karen Chan
- University of Hong Kong, Hong Kong, China
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | - Margaret Stanley
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Julia Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Australia
| | - Joel Palefsky
- University of California, San Francisco, San Francisco, United States
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25
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Nitkowski J, Fernandez ME, Ridolfi T, Chiao E, Giuliano AR, Schick V, Swartz MD, Smith JS, Nyitray AG. The Impact of Body Mass Index and Medical Conditions on Home-based Anal Self-Sampling. Res Sq 2023:rs.3.rs-2748914. [PMID: 37034807 PMCID: PMC10081437 DOI: 10.21203/rs.3.rs-2748914/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Purpose. Self-sampling is increasingly being used in screening programs, yet no studies to date have examined the impact of bodily characteristics on self-sampling experiences. Our objective was to assess whether body mass index (BMI) and physical disability were associated with anal self-sampling difficulty. Methods. We recruited sexual minority men (SMM) and trans persons in Milwaukee, Wisconsin to participate in an anal cancer screening study. Between January 2020 and August 2022, 240 participants were randomized to a home (n=120) or clinic (n=120) screening arm. Home participants received a mailed at-home anal self-sampling kit and were asked to attend a baseline clinic visit where biometric measurements were collected. Participants were asked to complete a survey about their experience with the kit. This research utilizes data from participants who used the kit and completed a baseline clinic visit and post-swab survey (n=82). We assessed the impact of BMI and physical disability on reported body or swab positioning difficulty. Results. Most participants reported no or little difficulty with body positioning (90.3%) or swab positioning (82.9%). Higher BMI was significantly associated with greater reported difficulty with body positioning (aOR=1.10, 95% CI 1.003-1.20, p =.04) and swab positioning (aOR=1.11, 95% CI 1.02-1.20, p =.01). Physical disability was not significantly associated with body or swab positioning difficulty. Specimen adequacy did not differ by BMI category ( p =.76) or physical disability ( p =.88). Conclusion. Anal self-sampling may be a viable option to reach obese persons who may be more likely to avoid screening due to weight-related barriers.
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Affiliation(s)
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health
| | | | | | | | - Vanessa Schick
- The University of Texas Health Science Center at Houston School of Public Health
| | - Michael D Swartz
- The University of Texas Health Science Center at Houston School of Public Health
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26
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Cousin L, Roberts S, Brownstein NC, Whiting J, Kasting ML, Head KJ, Vadaparampil ST, Giuliano AR, Gwede CK, Meade CD, Christy SM. Factors associated with parental COVID-19 vaccine attitudes and intentions among a national sample of United States adults ages 18-45. J Pediatr Nurs 2023; 69:108-115. [PMID: 36716520 PMCID: PMC9852321 DOI: 10.1016/j.pedn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE This study explored factors associated with parents' attitudes and intentions to seek information about the COVID-19 vaccine for their children (ages 0-18) and intentions to vaccinate their age-eligible children. DESIGN AND METHODS As part of an anonymous online cross-sectional survey, parents' vaccine attitudes, COVID-19 vaccine intentions for their children, health literacy, health numeracy, and sociodemographic variables were assessed. Multivariable ordered logistic regression models identified factors associated with parents' COVID-19 vaccine intentions for their children. RESULTS Parents/guardians (n = 963) were mostly White (82.3%), insured (88.0%), and college graduates (57.3%). Men reported higher intentions than women to seek information about the COVID-19 vaccine for their children (p = 0.003) and higher intentions to vaccinate their children (p = 0.049). Parental characteristics associated with increased intentions to have their children vaccinated included higher educational attainment (p < 0.001), more positive general vaccine attitudes (p < 0.001), preference for health information in a language other than English (p = 0.006), higher income (p = 0.048), having health insurance (p = 0.05), health literacy (p = 0.024), and health numeracy (p = 0.049). CONCLUSIONS Multiple sociodemographic characteristics including male gender, higher health literacy and numeracy, and language preference are noteworthy factors associated with parental COVID-19 vaccine intentions that could inform the planning and implementation of educational interventions. PRACTICE IMPLICATIONS Nurses are important sources of trusted information and play an important role in parent/family health education and in understanding myriad factors that may improve attitudes and enhance readiness toward vaccine uptake. Our findings emphasize the potential value of examining tailored/targeted COVID-19 vaccine education according to key influencing factors.
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Affiliation(s)
- Lakeshia Cousin
- College of Nursing, University of Florida, Gainesville, FL, United States of America
| | - Stephanie Roberts
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
| | - Naomi C Brownstein
- Dept. of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Junmin Whiting
- Dept. of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Monica L Kasting
- Dept. of Public Health, Purdue University, West Lafayette, IN, United States of America; Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America
| | - Katharine J Head
- Dept. of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Susan T Vadaparampil
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Anna R Giuliano
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Clement K Gwede
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Cathy D Meade
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Shannon M Christy
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America; Dept. of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Dept. of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America.
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27
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Wei F, Goodman MT, Xia N, Zhang J, Giuliano AR, D’Souza G, Hessol NA, Schim van der Loeff MF, Dai J, Neukam K, de Pokomandy A, Poynten IM, Geskus RB, Burgos J, Etienney I, Moscicki AB, Donà MG, Gillison ML, Nyitray AG, Nowak RG, Yunihastuti E, Zou H, Hidalgo-Tenorio C, Phanuphak N, Molina JM, Schofield AM, Kerr S, Fan S, Lu Y, Ong JJ, Chikandiwa AT, Teeraananchai S, Squillace N, Wiley DJ, Palefsky JM, Georges D, Alberts CJ, Clifford GM. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin Infect Dis 2023; 76:e692-e701. [PMID: 35869839 PMCID: PMC10226739 DOI: 10.1093/cid/ciac581] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. METHODS We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. RESULTS Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. CONCLUSIONS This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of CaliforniaSan Francisco, California, USA
| | | | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Maria Gabriella Donà
- Sexually Transmitted Infections (STI)/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maura L Gillison
- Thoracic Head and Neck Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carmen Hidalgo-Tenorio
- Early Clinical Trial Unit. Biosanitary Institute (IBS.Granada). Infectious Diseases Unit. University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Jean-Michel Molina
- Department of Infectious diseases, University of Paris Cité, St-Louis Hospital, Paris, France
| | - Alice M Schofield
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, and Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Nicola Squillace
- Infectious Diseases Unit ASST-Monza, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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Dickey BL, Giuliano AR, Sirak B, Abrahamsen M, Lazcano-Ponce E, Villa LL, Coghill AE. Control of Epstein-Barr Virus (EBV) in the Oral Cavity Is Associated With Persistence of Oral Human Papillomavirus (HPV)16/18 Among Men From the HPV Infection in Men Study. J Infect Dis 2023; 227:256-260. [PMID: 35679351 DOI: 10.1093/infdis/jiac223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-related oropharyngeal cancer (OPC) incidence is increasing among men. Biomarkers that can identify oral HPV16/18 infections likely to persist, the obligate precursor for HPV-OPC, are needed. METHODS We assessed the association between oral Epstein-Barr virus (EBV) and oral HPV16/18 persistence among 63 men in the HPV Infection in Men Study who tested positive for HPV16/18 at the baseline visit. Control of oral coinfections, including EBV, could serve as a biomarker of immune competence and the ability to control oral HPV. RESULTS Detection of oral EBV was significantly associated with oral HPV16/18 ≥12-month persistence. CONCLUSIONS Detection of oral EBV deserves evaluation as a biomarker for oral HPV persistence and HPV-related OPC.
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Affiliation(s)
- Brittney L Dickey
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bradley Sirak
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Martha Abrahamsen
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luisa L Villa
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo e Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Anna E Coghill
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Fujimoto K, Nyitray AG, Kuo J, Zhao J, Hwang LY, Chiao E, Giuliano AR, Schneider JA, Khanna A. Social networks, high-risk anal HPV and coinfection with HIV in young sexual minority men. Sex Transm Infect 2022; 98:557-563. [PMID: 35184046 PMCID: PMC9388701 DOI: 10.1136/sextrans-2021-055283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Young sexual minority men (SMM) exhibit a high prevalence and incidence of high-risk genotypes of human papillomavirus (hrHPV) anal infections and a confluence of a high prevalence of HIV and rectal STIs. Social determinants of health (SDOHs) are linked to social network contexts that generate and maintain racial disparities in HIV and STIs. A network perspective was provided to advance our knowledge of drivers of genotype-specific hrHPV infection and coinfection with HIV. The study also examined whether socially connected men are infected with the same high-risk HPV genotypes and, if so, whether this tendency is conditioned on coinfection with HIV. METHODS Our sample included 136 young SMM of predominantly black race and their network members of other races and ethnicities, aged 18-29 years, who resided in Houston, Texas, USA. These participants were recruited during 2014-2016 at the baseline recruitment period by network-based peer referral, where anal exfoliated cells and named social and sexual partners were collected. Exponential random graph models were estimated to assess similarity in genotype-specific hrHPV anal infection in social connections and coinfection with HIV in consideration of the effects of similarity in sociodemographic, sexual behavioural characteristics, SDOHs and syphilis infection. RESULTS Pairs of men socially connected to each other tend to be infected with the same hrHPV genotypes of HPV-16, HPV-45 and HPV-51 or HPV-16 and/or HPV-18. The tendency of social connections between pairs of men who were infected with either HPV-16 or HPV-18 were conditioned on HIV infection. CONCLUSIONS Networked patterns of hrHPV infection could be amenable to network-based HPV prevention interventions that engage young SMM of predominantly racial minority groups who are out of HIV care and vulnerable to high-risk HPV acquisition.
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Affiliation(s)
- Kayo Fujimoto
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacky Kuo
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jing Zhao
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lu-Yu Hwang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Epidemiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - John A Schneider
- Department of Medicine and Health Studies, University of Chicago, Chicago, Illinois, USA
| | - Aditya Khanna
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
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Giannone G, Giuliano AR, Bandini M, Marandino L, Raggi D, Earle W, Ayres B, Pettaway CA, McNeish IA, Spiess PE, Necchi A. HPV vaccination and HPV-related malignancies: impact, strategies and optimizations toward global immunization coverage. Cancer Treat Rev 2022; 111:102467. [DOI: 10.1016/j.ctrv.2022.102467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/02/2022]
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Wang WV, Kothari S, Skufca J, Giuliano AR, Sundström K, Nygård M, Koro C, Baay M, Verstraeten T, Luxembourg A, Saah AJ, Garland SM. Real-world impact and effectiveness of the quadrivalent HPV vaccine: an updated systematic literature review. Expert Rev Vaccines 2022; 21:1799-1817. [PMID: 36178094 DOI: 10.1080/14760584.2022.2129615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) infection, which poses significant disease burden, is decreasing following implementation of vaccination programs. Synthesized evidence on HPV vaccine real-world benefit was published in 2016. However, long-term impact of vaccination, and how vaccination programs influence infection rates and disease outcomes, requires further examination. AREAS COVERED We systematically reviewed observational studies on HPV vaccination within MEDLINE, EMBASE, and Google Scholar from 2016 to 2020, involving 14 years of follow-up data. We identified 138 peer-reviewed publications reporting HPV vaccine impact or effectiveness. Outcomes of interest included rates of infection at different anatomical sites and incidence of several HPV-related disease endpoints. EXPERT OPINION The expansion of HPV vaccination programs worldwide has led to a reduction in genital infection and significant decreases in incidence of HPV-related disease outcomes. Therefore, the WHO has set goals for the elimination of cervical cancer as a public health concern. To track progress toward this requires an understanding of the effectiveness of different vaccination initiatives. However, the impact on males, and potential benefit of gender-neutral vaccination programs have not been fully explored. To present an accurate commentary on the current outlook of vaccination and to help shape policy therefore requires a systematic review of available data.
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Affiliation(s)
- Wei Vivian Wang
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL USA
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Carol Koro
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Marc Baay
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Alain Luxembourg
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Alfred J Saah
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme LLC, Rahway, NJ, USA
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The University of Melbourne, Royal Women's Hospital (RWH), Murdoch Childrens Research Institute, Melbourne, Australia
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Gallen C, Dukes CW, Aldrich A, Macaisa L, Mo Q, Cubitt CL, Pilon-Thomas S, Giuliano AR, Czerniecki BJ, Costa RLB. Long-Term CD4 + T-Cell and Immunoglobulin G Immune Responses in Oncology Workers following COVID-19 Vaccination: An Interim Analysis of a Prospective Cohort Study. Vaccines (Basel) 2022; 10:1931. [PMID: 36423026 PMCID: PMC9696551 DOI: 10.3390/vaccines10111931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 09/08/2023] Open
Abstract
We conducted a prospective study to evaluate immune responses to SARS-CoV-2 in oncology workers in which we collected blood and clinical data every 6 months. Spike-specific CD4+ T-cells and immunoglobulin G responses were measured using interferon-gamma enzyme-linked immunosorbent spot and enzyme-linked immunosorbent assay, respectively. Sixty (81%) vaccinated and 14 (19%) unvaccinated individuals were enrolled. CD4+ T-cell responses of those individuals currently naturally infected were comparable to those who were 6 months from receiving their last dose of the vaccine; both responses were significantly higher than among those who were unvaccinated. Unvaccinated participants who became vaccinated while in the study showed a significant increase in both types of spike-specific immune responses. Previously vaccinated individuals who received a third dose (booster) showed a similar response to the spike protein. However, this response decreases as soon as 3 months but does not dip below the established response following two doses. Response to variants of concern B.1.617.2 (Delta) and B.1.1.529 (Omicron) also increased, with the Omicron variant having a significantly lower response when compared to Delta and the wild type. We conclude that antibody and T-cell responses increase in oncology workers after serial vaccination but can wane over time.
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Affiliation(s)
- Corey Gallen
- Department of Clinical Science, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Amy Aldrich
- Department of Clinical Science, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Lauren Macaisa
- Department of Clinical Science, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Qianxing Mo
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Brian J. Czerniecki
- Department of Clinical Science, Moffitt Cancer Center, Tampa, FL 33612, USA
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
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Zhu Y, Wu CF, Giuliano AR, Fernandez ME, Ortiz AP, Cazaban CG, Li R, Deshmukh AA, Sonawane K. Tdap-HPV vaccination bundling in the USA: Trends, predictors, and implications for vaccine series completion. Prev Med 2022; 164:107218. [PMID: 36007751 PMCID: PMC9691592 DOI: 10.1016/j.ypmed.2022.107218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) promotes taking a 'bundling approach' (i.e., administering Tetanus, diphtheria toxoids, and acellular pertussis [Tdap] and human papillomavirus [HPV] vaccines in the same way and on the same day) for adolescent vaccinations. Recent trends and patterns in Tdap-HPV vaccination bundling in the USA remain undocumented. In addition, the implications of bundling Tdap-HPV vaccination for HPV vaccine series completion remain unknown. To address these critical knowledge gaps, we performed a retrospective study using a nationwide sample of privately insured adolescents (Optum's de-identified Clinformatics® Data Mart Database). Tdap-HPV vaccination bundling (per 100 Tdap vaccination encounters) during 2014-2018 was estimated overall, for 50 states, and by adolescents' age, sex, and provider specialties. Survival model estimated the likelihood of series completion among 9-14-year-old adolescents. From 2014 to 2018, 560,806 adolescents received a Tdap vaccine of which 172,604 (30.8%) received the HPV vaccines on the same day. Tdap-HPV vaccination bundling (per 100 Tdap vaccinations) increased nationally, from 22.9 in 2014 to 39.1 in 2018 (Ptrend < 0.001); bundling was lowest in New York and New Jersey. The likelihood of receiving the Tdap and HPV vaccines bundled was higher for young and female adolescents. Adolescents who received their first HPV vaccine bundled with the Tdap vaccine were more likely to complete the series compared to those who received it alone (Hazards Ratio = 1.45; 1.43-1.48). HPV vaccination bundling has increased in recent years in the USA. The increased likelihood of HPV vaccine series completion provides important evidence supporting the adoption of same-day Tdap-HPV vaccine administration in clinical practice to boost HPV vaccination coverage.
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Affiliation(s)
- Yenan Zhu
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America; Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Chi-Fang Wu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ana P Ortiz
- Department of Biostatistics and Epidemiology, University of Puerto Rico Comprehensive Cancer Center, Puerto Rico
| | - Cecilia Ganduglia Cazaban
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ashish A Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
| | - Kalyani Sonawane
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America.
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Kasting ML, Christy SM, Reich RR, Rathwell JA, Roetzheim RG, Vadaparampil ST, Giuliano AR. Hepatitis C Virus Screening: Factors Associated With Test Completion in a Large Academic Health Care System. Public Health Rep 2022; 137:1136-1145. [PMID: 34694928 PMCID: PMC9574314 DOI: 10.1177/00333549211054085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In 2012, onetime hepatitis C virus (HCV) screening was recommended for all baby boomers (people born during 1945-1965) in the United States, but only 4.0%-12.9% of baby boomers have ever had a screening ordered by a health care provider. This study examined the HCV screening prevalence among adult patients in a large academic health care system and assessed factors associated with the completion of screening when ordered for baby boomers. METHODS We defined HCV screening completion as the completion of an HCV antibody test when it was ordered. We used electronic health records to examine HCV screening completion rates among adults (N = 106 630) from August 1, 2015, through July 31, 2020, by birth cohort. Among baby boomers whose health care provider ordered HCV screening, we examined frequency and percentages of HCV screening completion by sociodemographic and clinical characteristics. We conducted univariate and multivariable logistic regression analyses to assess factors associated with HCV screening completion among baby boomers. RESULTS During the study period, 73.0% of baby boomers completed HCV screening when it was ordered. HCV completion did not differ by sex or race and ethnicity among baby boomers. Baby boomers with Medicare supplemental health insurance compared with commercial health insurance (adjusted odds ratio [aOR] = 1.87) and those seeing only advanced practice professionals compared with specialty care physicians (aOR = 2.24) were more likely to complete HCV screening when it was ordered. CONCLUSIONS Noncompletion of HCV screening is one of many barriers along the HCV treatment continuum. Our findings suggest a need for interventions targeting systems, health care providers, and patients to increase HCV screening rates in the United States.
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Affiliation(s)
- Monica L. Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard R. Reich
- Biostatistics and Bioinformatics Shared Resource, Moffitt Cancer Center, Tampa, FL, USA
| | - Julie A. Rathwell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard G. Roetzheim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Family Medicine, University of South Florida, Tampa, FL, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
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Dickey BL, Nedjai B, Preece MD, Schell MJ, Boulware D, Whiting J, Sirak B, Abrahamsen M, Isaacs‐Soriano KA, Kennedy K, Chung CH, Giuliano AR. Methylation of HPV16 and EPB41L3 in oral gargles and the detection of early and late oropharyngeal cancer. Cancer Med 2022; 11:3735-3742. [PMID: 35619332 PMCID: PMC9582688 DOI: 10.1002/cam4.4757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
As oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) increases in men, the need for a screening test to diagnose OPC early is crucial. While HPV-associated OPC has a favorable prognosis, recurrence is likely, and metastatic OPC is often incurable regardless of HPV status. Our previous study of pretreatment, male OPC cases (n = 101) and age- and smoking-matched controls (n = 101) found methylation of the host EPB41L3 tumor suppressor gene and HPV16 in the oral gargle was correlated with these biomarkers in the tumor. Methylation of these genes in the oral gargle was significantly (p < 0.0001) higher among cases compared to controls. To further study the utility of HPV16/EPB41L3 methylation, we expanded the sample size and specifically increased the number of early OPC cases (T1-T2, N0-N1; small tumors with a single ipsilateral node <3 cm) to evaluate these biomarkers in early and late OPC. This study included 228 OPC cases, 92 of which were early cases and frequency matched to 142 healthy controls. In logistic regression, the AUC for HPV16/EPB41L3 methylation for all OPC cases was 0.82. Among early and late OPC cases, the AUC was 0.78 and 0.85, respectively. For early cases, 76% sensitivity was achieved, replicating results from our prior study, with a specificity of 65%, indicating room for improvement. The ability of HPV16/EPB41L3 methylation to distinguish OPC from healthy controls highlights its utility as a potential biomarker for OPC. However, the inability to predict early OPC better than late stage OPC indicates the need for additional biomarkers to improve screening performance.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Belinda Nedjai
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary UniversityLondonUK
| | - Matthew D. Preece
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary UniversityLondonUK
| | - Michael J. Schell
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - David Boulware
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Junmin Whiting
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Bradley Sirak
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Kimberly A. Isaacs‐Soriano
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Christine H. Chung
- Department of Head and Neck‐Endocrine OncologyH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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Amorrortu RP, Zhao Y, Fenske NA, Cherpelis BS, Messina JL, Giuliano AR, Sondak VK, Schell MJ, Mckay-Chopin S, Gheit T, Waterboer T, Tommasino M, Rollison DE. Natural History of Incident and Persistent Cutaneous Human Papillomavirus and Human Polyomavirus Infections. J Infect Dis 2022; 226:1162-1174. [PMID: 35022780 PMCID: PMC9518839 DOI: 10.1093/infdis/jiac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/07/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cutaneous human papillomaviruses (cuHPV) and polyomaviruses (HPyV) have been implicated in skin cancers; however, interpretation of findings across studies is complicated by limited understanding of the natural history of these infections across normal tissue types. METHODS In total, 675 eyebrow hair (EBH) and skin swab (SSW) samples were collected from 71 skin cancer screening patients every 6 months over 2 years and measured for presence of β-HPV, γ-HPV, and HPyV. Incidence, persistence, and clearance of cuHPV/HPyV were estimated, and risk factors associated with infection were examined. RESULTS Prevalence, incidence, and persistence of β-HPV, γ-HPV, and HPyV were consistently higher in SSW than in EBH, with types 5, 24, 49, 76 and Merkel cell polyomavirus (MCPyV) having incidence rates greater than 20 per 1000 person-months. Prevalent γ-HPV EBH infections persisted more often in women (P = .024), incident β-HPV EBH infections persisted less often among individuals with history of blistering sunburn (P = .019), and prevalent MCPyV SSW infections persisted more often in those with a history of skin cancer (P = .033). CONCLUSIONS Incidence and persistence of cuHPV/HPyV were observed in SSW and EBH; however, none of the risk factors examined were commonly associated with cuHPV/HPyV infections across normal tissue types.
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Affiliation(s)
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Neil A Fenske
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Basil S Cherpelis
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Jane L Messina
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Michael J Schell
- Biostatistics and Bioinformatics Shared Resource, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sandrine Mckay-Chopin
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tarik Gheit
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Massimo Tommasino
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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Umutoni V, Schabath MB, Nyitray AG, Wilkin TJ, Villa LL, Lazcano-Ponce E, Giuliano AR, Sudenga SL. The Association between Smoking and Anal Human Papillomavirus in the HPV Infection in Men Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1546-1553. [PMID: 35653709 PMCID: PMC9350906 DOI: 10.1158/1055-9965.epi-21-1373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Previous studies show an association between smoking and anal cancer. The objective of this study was to assess the association between smoking and anal HPV (human papillomavirus) prevalence, incidence, and persistence in men. METHODS The HPV Infection in Men (HIM) Study is a multinational study that enrolled HIV-negative men. At baseline and follow-up visits, anal specimens were collected. HPV genotyping was assessed by linear array. Prevalence ratios (PR) were used to assess the association between smoking and anal HPV prevalence. Odds ratios (OR) were used to assess the association between smoking and anal HPV incidence and ≥12-months persistence. RESULTS Current smokers have a higher prevalence [adjusted PR (aPR), 1.36; 95% confidence interval (CI), 1.06-1.73) and incidence [adjusted OR (aOR), 1.74; 95% CI, 1.26-2.39] and ≥12-months persistence (aOR, 1.67; 95% CI, 1.19-2.33) of any anal HPV compared with never smokers. There were no differences in the prevalence, incidence, or persistence of anal HPV between former and never smokers. Smoking status was not associated with the prevalence or persistence of anal HPV among men who have sex with men but was associated with higher incidence of HR-HPV. Among men that have sex with women (MSW), current smokers had an increased prevalence and incidence of LR-HPV compared with never smokers. CONCLUSIONS Current smokers had a higher prevalence, persistence, and incidence of HPV compared with never smokers. Further research is needed to assess the role smoking in anal HPV persistence and progression to disease. IMPACT Prevention initiatives should raise awareness about smoking and the risk factor of anal HPV infection and anal cancer.
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Affiliation(s)
- Victoria Umutoni
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew B. Schabath
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Luisa L. Villa
- School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Anna R. Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Staci L. Sudenga
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Corresponding Author: Staci L. Sudenga, Ph.D., Vanderbilt University Medical Center, 2525 West End Ave, Suite 800, Nashville, TN 37203, Telephone: 615-343-0953,
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Maldonado I, Plata M, Gonzalez M, Correa A, Nossa C, Giuliano AR, Joura EA, Ferenczy A, Ronnett BM, Stoler MH, Jin Zhou H, Joshi A, Das R, Bautista O, Group T, Luxembourg A, Saah A, Buchwald UK. Effectiveness, immunogenicity, and safety of the quadrivalent HPV vaccine in women and men aged 27–45 years. Hum Vaccin Immunother 2022; 18:2078626. [PMID: 35853188 PMCID: PMC9481115 DOI: 10.1080/21645515.2022.2078626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Among women aged 27–45 years, the quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) vaccine was generally well tolerated, efficacious, and immunogenic in the placebo-controlled FUTURE III study (NCT00090220; n = 3253). The qHPV vaccine was also generally well tolerated and highly immunogenic in men aged 27–45 years who participated in the single-cohort mid-adult male (MAM) study (NCT01432574; n = 150). Here, we report results of a long-term follow up (LTFU) extension of FUTURE III with up to 10 years follow-up. To understand the relevance of the mid-adult women LTFU study in the context of mid-adult men vaccination, we report results from post-hoc, cross-study immunogenicity analyses conducted to compare immunogenicity (geometric mean titers; GMTs) at 1-month post-qHPV vaccine dose 3 in women and men aged 27–45 years versus women and men aged 16–26 years from prior efficacy studies. The qHPV vaccine demonstrated durable protection against the combined endpoint of HPV6/11/16/18-related high-grade cervical dysplasia and genital warts up to 10 years (median 8.9) post-dose 3 and sustained HPV6/11/16/18 antibody responses through approximately 10 years in women aged 27–45 years. Efficacy of qHPV vaccine in men aged 27–45 years was inferred based on the cross-study analysis of qHPV vaccine immunogenicity demonstrating non-inferior HPV6/11/16/18 antibody responses in men aged 27–45 years versus 16–26 years. In conclusion, durable effectiveness of the qHPV vaccine was demonstrated in women 27–45 years of age, and vaccine efficacy was inferred in men 27–45 years of age based on the serological results.
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Affiliation(s)
- Ivette Maldonado
- Department of Obstetrics & Gynaecology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Manuel Plata
- Department of Gynaecology, Fundación Cardioinfantil, Bogotá, Colombia
| | - Mauricio Gonzalez
- Ginecologo Oncologo, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Elmar A. Joura
- Department of Obstetrics & Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Alex Ferenczy
- Department of Gynecologic Pathology and Cytopathology, University Health Center and Jewish General Hospital, Montreal, Quebec, Canada
| | - Brigitte M. Ronnett
- Johns Hopkins Gynecologic Pathology Consultation Service, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark H. Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
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Brownstein NC, Reddy H, Whiting J, Kasting ML, Head KJ, Vadaparampil ST, Giuliano AR, Gwede CK, Meade CD, Christy SM. COVID-19 vaccine behaviors and intentions among a national sample of United States adults ages 18-45. Prev Med 2022; 160:107038. [PMID: 35398369 PMCID: PMC8988441 DOI: 10.1016/j.ypmed.2022.107038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/31/2021] [Accepted: 04/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vaccination for SARS-CoV-2, the virus that causes COVID-19 illness, is an important public health tool to reduce hospitalizations and deaths. PURPOSE This report focuses on intentions and behaviors related to COVID-19 vaccination among United States (U.S.) adults ages 18-45. METHODS From February 25-March 24, 2021, we conducted an online survey assessing COVID-19 vaccine intentions and behaviors, health beliefs, vaccine attitudes, and sociodemographic characteristics. Participants were adults aged 18-45, living throughout the U.S. with oversampling in Florida, panelists of a research panel company directly or via verified partners, and able to read, write, and understand English. Associations between COVID-19 vaccination uptake, intentions, and other study variables were examined through multivariable logistic and proportional odds regression analyses. RESULTS Among participants in the final analytic sample (n = 2722), 18% reported having received at least one dose of a COVID-19 vaccine. Approximately 31% of unvaccinated participants reported strong intentions to receive a COVID-19 vaccine in the next year, whereas 35% reported strong intentions to receive a COVID-19 vaccine if it were strongly recommended by a healthcare provider. All COVID-19 vaccination outcomes were associated with male gender, sexual minority status, higher levels of education, and previous influenza vaccination. All vaccination intention outcomes were associated with vaccine attitudes and geographic region. Vaccination status and intentions were differentially associated with multiple additional sociodemographic, attitudinal, and/or healthcare experience variables. CONCLUSIONS Several demographic variables, vaccine attitudes, and healthcare experiences were found to contribute to COVID-19 vaccine receipt and intentions. Targeted efforts are necessary to increase uptake of the vaccine in the U.S.
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Affiliation(s)
- Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Oncologic Sciences, University of South Florida, United States of America.
| | - Harika Reddy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; College of Public Health and Health Professions, University of Florida, United States of America
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, United States of America; Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Susan T Vadaparampil
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Clement K Gwede
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Cathy D Meade
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Shannon M Christy
- Department of Oncologic Sciences, University of South Florida, United States of America; Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
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Arevalo M, Brownstein NC, Whiting J, Meade CD, Gwede CK, Vadaparampil ST, Tillery KJ, Islam JY, Giuliano AR, Christy SM. Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study. JMIR Form Res 2022; 6:e35797. [PMID: 35737436 PMCID: PMC9264135 DOI: 10.2196/35797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported. Objective The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements. Methods Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators. Results Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample. Conclusions Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
| | - Kristin J Tillery
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL, United States
| | - Jessica Y Islam
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Anna R Giuliano
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
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Dickey BL, Giuliano AR, Sirak B, Abrahamsen M, Lazcano-Ponce E, Villa LL, Coghill AE. Abstract 2264: Co-infection with Epstein-Barr virus impacts oral HPV persistence. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Rates of oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) infection are increasing in men. The obligate precursor to OPC is a persistent infection with an oncogenic HPV type that is unable to be cleared via natural immunity alone. However, the factors that influence HPV persistence at the oral cavity are unknown. It is plausible that long-term infection with other pathogens at the same anatomic site indicates an overall inability to clear an oral infection. Epstein-Barr virus (EBV) is a saliva-transmitted gamma herpesvirus that infects 90% of the population by adulthood and replicates in the epithelial cells of the oropharynx. This study aimed to investigate whether oral EBV shedding, a marker of active viral replication, could serve as a biomarker for persistent, oncogenic oral HPV infection in men. Men with an HPV16 or 18 oral infection present at the baseline visit of the HPV Infection in Men (HIM) Study were included (n=63). Briefly, men from Tampa, FL, U.S.; Cuernavaca, Mexico; and Sao Paolo, Brazil were followed every 6 months for a median of 4.1 years. Men completed a risk factor questionnaire and provided an oral gargle sample at each visit. For this study, the baseline, 6-month, and 12-month oral specimens were HPV genotyped using the SPF10 PCR-DEIA-LiPA25 system. Presence of EBV was evaluated in the baseline specimen using PCR to amplify and quantify the EBV DNA on the Rotor-Gene Q MDx instrument. Men with the same oral HPV type present at the 6-month and 12-month visit were categorized as 6-month and 12-month oral HPV persistent, respectively. The association between EBV and persistent HPV infection was investigated using a logistic regression model adjusted for age, country, and smoking. Among 63 men with oral HPV 16/18 infection at baseline, 44 HPV infections did not persist, 19 persisted to at least 6-months and 11 persisted to at least 12 months. Among the total sample, 32 also had EBV detected in the oral gargle at baseline. Among men who did not have a persistent HPV infection, 21 (47.7%) had EBV detected at baseline while 11 (57.9%) men with an HPV infection that persisted at least 6 months had detectable EBV at baseline; and 9 (81.8%) of the men who persisted to 12 months had EBV detected. Mean EBV viral load was highest among men who persisted to at least 12 months (5.0 log copies/ml) and was significantly higher than men who did not persist (2.5 log copies/ml; p=0.047). Detection of oral EBV at baseline was significantly associated with elevated risk of ≥12-month oral HPV 16/18 persistence (aOR: 9.90; 95% CI: 1.38-70.96), but not ≥6-month HPV 16/18 persistence (aOR: 1.62; 95% CI: 0.52-5.06).These data support the hypothesis that EBV reactivation may be a biomarker of poor immune control leading to increased risk of oral HPV persistence. The use of a biomarker that identifies men whose HPV infection may persist would be a useful tool to allow for screening and early detection of OPC.
Citation Format: Brittney L. Dickey, Anna R. Giuliano, Bradley Sirak, Martha Abrahamsen, Eduardo Lazcano-Ponce, Luisa L. Villa, Anna E. Coghill. Co-infection with Epstein-Barr virus impacts oral HPV persistence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2264.
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Affiliation(s)
| | | | | | | | | | - Luisa L. Villa
- 3Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Christy SM, Reich RR, Rathwell JA, Vadaparampil ST, Isaacs-Soriano KA, Friedman MS, Roetzheim RG, Giuliano AR. Using the Electronic Health Record to Characterize the Hepatitis C Virus Care Cascade. Public Health Rep 2022; 137:498-505. [PMID: 33831316 PMCID: PMC9109542 DOI: 10.1177/00333549211005812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Chronic hepatitis C virus (HCV) infection is one of the main causes of hepatocellular carcinoma. Before initiating a multilevel HCV screening intervention, we sought to (1) describe concordance between the electronic health record (EHR) data warehouse and manual medical record review in recording aspects of HCV testing and treatment and (2) estimate the percentage of patients with chronic HCV infection who initiated and completed HCV treatment using manual medical record review. METHODS We examined the medical records for 177 patients (100 randomly selected patients born during 1945-1965 without evidence of HCV testing and 77 adult patients of any birth cohort who had completed HCV testing) with a primary care or relevant specialist visit at an academic health care system in Tampa, Florida, from 2015 through 2018. We used the Cohen κ coefficient to examine the degree of concordance between the searchable data warehouse and the medical record review abstractions. Descriptive statistics characterized referral to and receipt of treatment among patients with chronic HCV infection from medical record review. RESULTS We found generally good concordance between the data warehouse abstraction and medical record review for HCV testing data (κ ranged from 0.66 to 0.87). However, the data warehouse failed to capture data on HCV treatment variables. According to medical record review, 28 patients had chronic HCV infection; 16 patients were prescribed treatment, 14 initiated treatment, and 9 achieved and had a reported posttreatment undetected HCV viral load. CONCLUSIONS Using data warehouse data provides generally reliable HCV testing information. However, without the use of natural language processing and purposeful EHR design, manual medical record reviews will likely be required to characterize treatment initiation and completion.
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Affiliation(s)
- Shannon M. Christy
- Department of Health Outcomes and Behavior, Division of
Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL,
USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, FL, USA
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine,
University of South Florida, Tampa, FL, USA
| | - Richard R. Reich
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt
Cancer Center and Research Institute, Tampa, FL, USA
| | - Julie A. Rathwell
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Epidemiology, Division of Population Science,
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Division of
Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL,
USA
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine,
University of South Florida, Tampa, FL, USA
| | - Kimberly A. Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Epidemiology, Division of Population Science,
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mark S. Friedman
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine,
University of South Florida, Tampa, FL, USA
| | - Richard G. Roetzheim
- Department of Health Outcomes and Behavior, Division of
Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL,
USA
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Family Medicine, Morsani College of Medicine,
University of South Florida, Tampa, FL, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine,
University of South Florida, Tampa, FL, USA
- Department of Cancer Epidemiology, Division of Population Science,
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Tota JE, Giuliano AR, Goldstone SE, Dubin B, Saah A, Luxembourg A, Velicer C, Palefsky JM. Anogenital Human Papillomavirus (HPV) Infection, Seroprevalence, and Risk Factors for HPV Seropositivity Among Sexually Active Men Enrolled in a Global HPV Vaccine Trial. Clin Infect Dis 2022; 74:1247-1256. [PMID: 34265048 DOI: 10.1093/cid/ciab603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In men, the incidence of human papillomavirus (HPV)-related cancer is rising, but data regarding male HPV infection and seroprevalence are available from only a few countries. METHODS This analysis of a global HPV vaccine trial evaluated baseline data from 1399 human immunodeficiency virus-negative heterosexual men (HM) and men who have sex with men (MSM). Key objectives included assessment of HPV prevalence and risk factors for seropositivity to 9-valent HPV (9vHPV) vaccine types (6, 11, 16, 18, 31, 33, 45, 52, and 58), and concordance between seropositivity and prevalent HPV type. RESULTS Overall, 455 of 3463 HM (13.1%) and 228 of 602 MSM (37.9%) were HPV DNA positive for any 9vHPV vaccine type at baseline. Infection prevalence and seroprevalence (≥1 9vHPV vaccine type) were 13.2% and 8.1%, respectively, among 333 HM from Europe, and 37.9% and 29.9%, respectively, among 335 MSM from Europe or North America. Among men with baseline infection, MSM had higher seroprevalence for concordant HPV types (39.5% vs 10.8% in HM). The seropositivity risk (irrespective of baseline infection status) was higher among MSM versus HM (age-adjusted odds ratio, 3.0 [95% confidence interval, 2.4-6.4]). Among MSM, statistically significant seropositivity risk factors included younger age at sexual debut, higher number of receptive anal sex partners, and less frequent condom use. No factors assessed were associated with seropositivity in HM. CONCLUSIONS Higher proportions of MSM than HM were HPV DNA positive and seropositive, and concordance between HPV DNA positivity and seropositivity, a potential marker of true infection versus carriage, was higher in MSM. Most MSM and HM were seronegative for all 9vHPV vaccine types, suggesting the potential benefit of catch-up vaccination after sexual debut.Clinical Trials Registration. NCT00090285.
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Affiliation(s)
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | | | | | | | | | - Joel M Palefsky
- Department of Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
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Damgacioglu H, Sonawane K, Chhatwal J, Lairson DR, Clifford GM, Giuliano AR, Deshmukh AA. Long-term impact of HPV vaccination and COVID-19 pandemic on oropharyngeal cancer incidence and burden among men in the USA: A modeling study. Lancet Reg Health Am 2022; 8:100143. [PMID: 34927126 PMCID: PMC8672648 DOI: 10.1016/j.lana.2021.100143] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oropharyngeal cancer (OPC) incidence is rising rapidly among men in the United States of America (USA). We aimed to project the impact of maintaining the current HPV vaccination uptake and achieving 80% national (Healthy People) goal on OPC incidence and burden. METHODS We developed an open-cohort micro-simulation model of OPC natural history among contemporary and future birth cohorts of men, accounting for sexual behaviors, population growth, aging, and herd immunity. We used data from nationally representative databases, cancer registries from all 50 states, large clinical trials, and literature. We evaluated the status quo scenario (the current HPV vaccination uptake remained stable) and alternative scenarios of improvements in uptake rates in adolescents (aged 9-17 years) and young adults (aged 18-26 years) by 2025 to achieve and maintain the 80% goal. The primary outcome was to project OPC incidence and burden from 2009 to 2100. We also assessed the impact of disruption in HPV vaccine uptake during the COVID-19 pandemic. FINDINGS OPC incidence is projected to rise until the mid-2030s, reaching the age-standardized incidence rate of 9·8 (95% uncertainty interval [UI] 9·5-10·1) per 100 000 men, with the peak annual burden of 23 850 (UI, 23 200-24 500) cases. Under the status quo scenario, HPV vaccination could prevent 124 000 (UI, 117 000-131 000) by 2060, 400 000 (UI, 384 000-416 000) by 2080, and 792 000 (UI, 763 000-821 000) by 2100 OPC cases among men. Achievement and maintenance of 80% coverage among adolescent girls only, adolescent girls and boys, and adolescents plus young adults could prevent an additional number of 100 000 (UI, 95 000-105 000), 118 000 (UI, 113 000-123 000), and 142 000 (UI, 136 000-148 000) male OPC cases by 2100. Delayed recovery of the HPV vaccine uptake during the COVID-19 pandemic could lead to 600 (UI, 580-620) to 6200 (UI, 5940-6460) additional male OPC cases by 2100, conditional on the decline in the extent of the national HPV vaccination coverage and potential delay in rebounding. INTERPRETATION Oropharyngeal cancer burden is projected to rise among men in the USA. Nationwide efforts to achieve the HPV vaccination goal of 80% coverage should be a public health priority. Rapid recovery of the declined HPV vaccination uptake during the COVID-19 pandemic is also crucial to prevent future excess OPC burden. FUNDING National Cancer Institute and National Institute on Minority Health and Health Disparities of the USA.
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Affiliation(s)
- Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
- Center for Healthcare Data, Department of Management, Policy & Community Health, School of Public Health, UT Health Science Center at Houston, Houston, TX, USA
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - David R. Lairson
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy & Community Health, UTHealth School of Public Health, 1200 Pressler Street, RAS-E 329, Houston, Texas, USA
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Giuliano AR, Lancet JE, Pilon-Thomas S, Dong N, Jain AG, Tan E, Ball S, Tworoger SS, Siegel EM, Whiting J, Mo Q, Cubitt CL, Dukes CW, Hensel JA, Keenan RJ, Hwu P. Evaluation of Antibody Response to SARS-CoV-2 mRNA-1273 Vaccination in Patients With Cancer in Florida. JAMA Oncol 2022; 8:748-754. [PMID: 35266953 PMCID: PMC8914884 DOI: 10.1001/jamaoncol.2022.0001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Patients with cancer experience high rates of morbidity and mortality after SARS-CoV-2 infection. Immune response to mRNA-1273 vaccination across multiple cancer types and treatments remains to be established. Objective To quantitate antibody responses after mRNA-1273 vaccination among patients with solid tumors and hematologic cancer and to assess clinical and treatment factors associated with vaccine response. Design, Setting, and Participants This cohort study included patients with cancer who were aged 18 years or older, spoke English or Spanish, had received their first mRNA-1273 dose between January 12 and 25, 2021, and agreed to blood tests before and after vaccination. Exposures Receipt of 1 and 2 mRNA-1273 SARS-CoV-2 vaccine doses. Main Outcomes and Measures Seroconversion after each vaccine dose and IgG levels against SARS-CoV-2 spike protein obtained immediately before the first and second vaccine doses and 57 days (plus or minus 14 days) after the first vaccine dose. Cancer diagnoses and treatments were ascertained by medical record review. Serostatus was assessed via enzyme-linked immunosorbent assay. Paired t tests were applied to examine days 1, 29, and 57 SARS-CoV-2 antibody levels. Binding antibody IgG geometric mean titers were calculated based on log10-transformed values. Results The 515 participants were a mean (SD) age of 64.5 (11.4) years; 262 (50.9%) were women; and 32 (6.2%) were Hispanic individuals and 479 (93.0%) White individuals; race and ethnicity data on 4 (0.7%) participants were missing. Seropositivity after vaccine dose 2 was 90.3% (465; 95% CI, 87.4%-92.7%) among patients with cancer, was significantly lower among patients with hematologic cancer (84.7% [255]; 95% CI, 80.1%-88.6%) vs solid tumors (98.1% [210]; 95% CI, 95.3%-99.5%), and was lowest among patients with lymphoid cancer (70.0% [77]; 95% CI, 60.5%-78.4%). Patients receiving a vaccination within 6 months after anti-CD20 monoclonal antibody treatment had a significantly lower seroconversion (6.3% [1]; 95% CI, 0.2%-30.2%) compared with those treated 6 to 24 months earlier (53.3% [8]; 95% CI, 26.6%-78.7%) or those who never received anti-CD20 treatment (94.2% [456]; 95% CI, 91.7%-96.1%). Low antibody levels after vaccination were observed among patients treated with anti-CD20 within 6 months before vaccination (GM, 15.5 AU/mL; 95% CI, 9.8-24.5 AU/mL), patients treated with small molecules (GM, 646.7 AU/mL; 95% CI, 441.9-946.5 AU/mL), and patients with low lymphocyte (GM, 547.4 AU/mL; 95% CI, 375.5-797.7 AU/mL) and IgG (GM, 494.7 AU/mL; 95% CI, 304.9-802.7 AU/mL) levels. Conclusions and Relevance This cohort study found that the mRNA-1273 SARS-CoV-2 vaccine induced variable antibody responses that differed by cancer diagnosis and treatment received. These findings suggest that patients with hematologic cancer and those who are receiving immunosuppressive treatments may need additional vaccination doses.
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Affiliation(s)
| | | | | | - Ning Dong
- Moffitt Cancer Center, Tampa, Florida
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47
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Gonçalves MG, Ferreira MT, Lopéz RVM, Ferreira S, Sirak B, Baggio ML, Lazcano-Ponce E, Nyitray AG, Giuliano AR, Villa LL, Sichero L. Prevalence and persistence of HPV-16 molecular variants in the anal canal of men: The HIM Study. J Clin Virol 2022; 149:105128. [DOI: 10.1016/j.jcv.2022.105128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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48
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Giuliano AR, Pilon-Thomas S, Schell MJ, Abrahamsen M, Islam JY, Isaacs-Soriano K, Kennedy K, Dukes CW, Whiting J, Rathwell J, Hensel JA, Mangual LN, Schonbrunn E, Bikowitz M, Grassie D, Yang Y. SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, October 2020-March 2021. Emerg Infect Dis 2022; 28:556-563. [PMID: 35081021 PMCID: PMC8888241 DOI: 10.3201/eid2803.211495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Estimating the actual extent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging because virus test positivity data undercount the actual number and proportion of persons infected. SARS-CoV-2 seroprevalence is a marker of past SARS-CoV-2 infection regardless of presence or severity of symptoms and therefore is a robust biomarker of infection period prevalence. We estimated SARS-CoV-2 seroprevalence among residents of Hillsborough County, Florida, USA, to determine factors independently associated with SARS-CoV-2 antibody status overall and among asymptomatic antibody-positive persons. Among 867 participants, SARS-CoV-2 period prevalence (October 2020–March 2021) was 19.5% (asymptomatic seroprevalence was 8%). Seroprevalence was 2-fold higher than reported SARS-CoV-2 virus test positivity. Factors related to social distancing (e.g., essential worker status, not practicing social distancing, contact with a virus-positive person, and length of contact exposure time) were consistently associated with seroprevalence but did not differ by time since suspected or known infection (<6 months vs. >6 months).
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Portillo-Romero AJ, Allen-Leigh B, Nyitray AG, Carnalla M, Salmerón J, León-Maldonado L, Yunes E, Rivera L, Magis-Rodríguez C, Vargas G, Giuliano AR, Esquivel-Ocampo EA, Lazcano-Ponce E. Sex Work and High-Risk Anal Human Papillomavirus Infection Among Transgender Women: The Condesa Study. Transgend Health 2022; 6:315-324. [PMID: 34993304 DOI: 10.1089/trgh.2020.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The prevalence of high-risk human papillomavirus (hrHPV) infection among transgender women has been reported to be very high and sexually transmitted infection (STI) prevention strategies have focused on transgender women who engage in sex work. The purpose of our study was to describe hrHPV infection prevalence among a group of transgender women and to explore the differences according to sex work history (SW). Methods: The Condesa Study, an HPV vaccine, and screening study, recruited 207 transgender women without previous HPV vaccination, ages 18-60, from two clinics in Mexico City that provide HIV and transgender health care (May 2018-December 2019). At enrollment, they completed a questionnaire on sociodemographic and sexual behavior data. The hrHPV DNA genotyping was done on self-collected anal samples. Factors associated with hrHPV, stratified by presence or absence of SW, were assessed with multiple logistic regression. Results: A total of 43.5% of participants reported a history of SW. Anal hrHPV prevalence was 62.0% among participants with a history of SW and 52.0% among those without. Overall, 1 in 4 (26.6%) participants were living with HIV. Independent risk factors associated with hrHPV among transgender women with a history of SW were younger age, younger age at first anal intercourse (15-17 years), and greater number of sexual partners in the last 3 months. Among transgender women who had not done SW, greater number of sexual partners in the last 3 months and self-reported STIs were associated with hrHPV. Conclusions: Prevalence of anal infection with hrHPV was high among transgender women. Our results support that other sexual behaviors different from participating in SW contribute to the high prevalence of HPV and that there is an urgent need to include all transgender women in prevention programs for HPV and associated cancers, regardless of SW.
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Affiliation(s)
| | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alan G Nyitray
- Clinical Cancer Center, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Martha Carnalla
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Salmerón
- Center for Research in Policy, Population and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Leith León-Maldonado
- National Council of Science and Technology (CONACYT)-National Institute of Public Health, Cuernavaca, Mexico
| | - Elsa Yunes
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Leonor Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Galileo Vargas
- Center for the Prevention and Comprehensive Care of HIV/AIDS in Mexico City, Condesa Clinic, Mexico City, Mexico
| | - Anna R Giuliano
- Center for Infection in Cancer Research, Moffitt Cancer Center, Tampa, Florida, USA
| | - Eiberth A Esquivel-Ocampo
- Coloproctology Unit of General Hospital of Cuernavaca, "Dr. José G. Parres," Cuernavaca, Morelos, México
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50
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Sudenga SL, Lotspeich SC, Nyitray AG, Sirak B, Shepherd BE, Messina J, Sereday KA, Silva RC, Abrahamsen M, Baggio ML, Quiterio M, Lazcano-Ponce E, Villa L, Giuliano AR. The Role of External Genital Lesions in Human Immunodeficiency Virus Seroconversion Among Men Participating in a Multinational Study. Sex Transm Dis 2022; 49:55-58. [PMID: 34282740 PMCID: PMC8722569 DOI: 10.1097/olq.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies in women have shown an increased risk of human immunodeficiency virus (HIV) acquisition with prior human papilloma virus (HPV) infection; however, few studies have been conducted among men. Our objective was to assess whether HPV-related external genital lesions (EGLs) increase risk of HIV seroconversion among men. METHODS A total of 1379 HIV-negative men aged 18 to 70 years from the United States, Mexico, and Brazil were followed for up to 7 years and underwent clinical examination for EGLs and blood draws every 6 months. Human immunodeficiency virus seroconversion was assessed in archived serum. Cox proportional hazards and marginal structural models assessed the association between EGL status and time to HIV seroconversion. RESULTS Twenty-nine participants HIV seroconverted during follow-up. Older age was associated with a lower hazard of HIV seroconversion. We found no significant difference in the risk of HIV seroconversion between men with and without EGLs (adjusted hazard ratio, 0.94; 95% confidence interval, 0.32-2.74). Stratified analyses focusing on men that have sex with men found no association between EGLs and HIV seroconversion risk (hazards ratio, 0.63; 95% confidence interval, 0.00-1.86). CONCLUSIONS External genital lesions were not associated with higher risk for HIV seroconversion in this multinational population, although statistical power was limited as there were few HIV seroconversions. Results may differ in populations at higher risk for HIV.
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Affiliation(s)
- Staci L. Sudenga
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah C. Lotspeich
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan G. Nyitray
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jane Messina
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Karen A. Sereday
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Roberto Carvalho Silva
- Centro de Referência e Treinamento DST/AIDS and Centro Universitário FAM, São Paulo, Brazil
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Maria Luiza Baggio
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Luisa Villa
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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