Gypsyamber D'Souza

Publications (2)13.58 Total impact

• Article: Invasive cervical cancer risk among HIV-infected women: A North American multi-cohort collaboration prospective study.

  Alison G Abraham, Howard D Strickler, Yuezhou Jing, Stephen J Gange, Timothy R Sterling, Michael Silverberg, Michael Saag, Sean Rourke, Anita Rachlis, Sonia Napravnik, [......], James J Goedert, M John Gill, Kelly Gebo, Joseph J Eron, Eric A Engels, Robert Dubrow, Heidi M Crane, John T Brooks, Ronald Bosch, Gypsyamber D'Souza
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  ABSTRACT: OBJECTIVE:: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic HPV infection - the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. METHODS:: Data were obtained from HIV-infected and -uninfected female participants in the NA-ACCORD with no history of ICC at enrollment. Participants were followed from study entry or January, 1996 through ICC, loss-to follow-up or December, 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios (SIR). All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. RESULTS:: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years (pys) of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 pys, respectively). HIV-infected women with baseline CD4+ T-cells of ≥350, 200-349 and <200 cells/uL had a 2.3-times, 3.0-times and 7.7-times increase in ICC incidence, respectively, compared with HIV-uninfected women (Ptrend =0.001). Of the 17 HIV-infected cases, medical records for the 5 years prior to diagnosis showed that 6 had no documented screening, 5 had screening with low grade or normal results, and 6 had high-grade results. CONCLUSIONS:: This study found elevated incidence of ICC in HIV-infected compared to -uninfected women, and these rates increased with immunosuppression.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2012; · 4.43 Impact Factor
• Article: Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America.

  Michael J Silverberg, Bryan Lau, Amy C Justice, Eric Engels, M John Gill, James J Goedert, Gregory D Kirk, Gypsyamber D'Souza, Ronald J Bosch, John T Brooks, [......], Marina B Klein, Richard D Moore, Benigno Rodriguez, Sean B Rourke, Michael S Saag, Timothy R Sterling, Kelly A Gebo, Natasha Press, Jeffrey N Martin, Robert Dubrow
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  ABSTRACT: Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends. In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men). Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7-151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5-61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8-6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5-2.2). In comparison with the period 2000-2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3-.9) in 1996-1999 and 0.9 (95% CI, .6-1.2) in 2004-2007. Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued.
  Clinical Infectious Diseases 04/2012; 54(7):1026-34. · 9.15 Impact Factor