HPV-16 AND CIGARETTE-SMOKING AS RISK-FACTORS FOR HIGH-GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA

Although genital human papillomavirus (HPV) infection is well establis hed as the etiologic agent for cervical intraepithelial neoplasia (CIN ), little is known about the cofactors involved in the development of high-grade lesions or the progression of low-grade to high-grade lesio ns. In our study of HPV-infected women with CIN (163 CIN I, 51 CIN II and 44 CIN III), women with CIN II or III were compared with those wit h CIN I for risk factors associated with high-grade lesions. After con trolling for age, education, ethnicity and frequency of Pap smear scre ening, infection with HPV 16, but not high viral load or infection wit h multiple types, was associated with high-grade lesions (OR for CIN I I = 11.96, OR for CIN III = 23.74). Risk of CIN III, but not CIN II, i ncreased with number of cigarettes smoked per day (ORs = 1.49 and 3.35 for less than or equal to 10 and > 10 cigarettes per day, respectivel y) and decreased with frequency of condom use during sex (ORs = 0.60 a nd 0.32 for women who used condoms occasionally/sometimes and most! al l of the time, respectively). There were no associations between high- grade lesions and plasma levels of micronutrients (retinol, p-carotene , alpha-tocopherol and reduced ascorbic acid). Our results indicate th at infection with HPV 16 is associated with high-grade lesions. Additi onal cofactors, such as cigarette smoking, may be required as a carcin ogen to advance HPV-infected cells toward neoplastic progression. Int. J. Cancer 78:28 1-285, 1998. (C) 1998 Wiley-Liss, Inc.