Abstract
PurposeThis prospective study aimed to examine the combined effect of viral load and alcohol consumption on the risk of persistent high-risk (HR) human papillomavirus (HPV) infection.MethodsAmong women undergoing health screening between 2002 and 2011 at the National Cancer Center, 284 and 122 women with HR-HPV infection and cytological findings of low-grade squamous intraepithelial or lower-grade lesions were followed up for 1 and 2 years, respectively. Multivariate logistic regression analysis was performed, and the relative excess risk due to interaction (RERI) and synergy index (S) were calculated.ResultsAmong drinkers, the risks of 1-year (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.05–8.18) and 2-year persistence (OR 8.08, CI 2.36–27.6) were significantly higher for high HPV loads than for low HPV loads; this association was not seen for non-drinkers. The risks for 1-year (OR 4.14, CI 1.89–9.05) and 2-year persistence (OR 6.61, CI 2.09–20.9) were significantly higher in subjects with a high HPV load who were also drinkers than in those who were non-drinkers. A high HPV load together with a longer drinking duration or higher alcohol consumption was associated with increased risks of 1-year (OR 3.07, CI 1.40–6.75 or OR 2.05, CI 0.87–4.83) and 2-year persistence (OR 6.40, CI 1.72–23.8 or OR 4.14, CI 1.18–14.6). The synergistic effect of alcohol consumption and HR-HPV load was stronger on the risk of 2-year persistence (RERI = 3.26, S = 2.38) than on the risk of 1-year persistence (RERI = 1.21, S = 1.63).ConclusionsThe synergistic effect of HR-HPV load and alcohol consumption was associated with the risk of HR-HPV persistence and was stronger for longer-term HR-HPV infection. Limiting alcohol consumption might be an important measure to prevent the development of cervical cancer in women with a high HR-HPV load.
Highlights
Persistent high-risk human papillomavirus (HR-HPV) infection is an important cause of cervical intraepithelial neoplasia (CIN) and cervical cancer [1,2,3]
To investigate the combined effects of viral load and cigarette smoking, two studies reported an association between cigarette smoking and HPV-16 DNA load in cervical carcinoma in situ (CIS) development and low-grade cytological abnormalities [18,19]
Our findings demonstrate an effect of the combination of HRHPV load and alcohol consumption on the risk of HPV persistence in women with normal or low-grade cytological abnormalities; a high viral load and alcohol behaviors may synergistically affect the risk of HR-HPV persistence
Summary
Persistent high-risk human papillomavirus (HR-HPV) infection is an important cause of cervical intraepithelial neoplasia (CIN) and cervical cancer [1,2,3]. HPV persistence is associated with virus-related factors such as viral genotype, multiplicity of infection, and viral load [4] as well as host-related factors, including old age [2], multiple lifetime sexual partners [5], cigarette smoking [5], compromised immune response [6], and oral contraceptive use [7]. Among these factors, the use of HR-HPV load as a marker for predictor of persistence remains controversial. To our knowledge, except for our previous study [20], research on the combined effect of HPV load and alcohol consumption on cervical cancer development has not been undertaken
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