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Biomedical subjects

A B Moscicki

Publications and source records attributed to A B Moscicki.

At least 37 records · Page 2Linked to original sources
PubMed1999

Risk factors for abnormal anal cytology in young heterosexual women.

Although anal cancers are up to four times more common in women than men, little is known about the natural history of anal human papillomavirus (HPV) infections and HPV-related anal lesions in women. This study reports on the prevalence of and risks for anal cytological abnormalities over a 1-year period in a cohort of young women participating in a study of the natural history of cervical HPV infection. In addition to their regularly scheduled sexual behavior interviews and cervical testing, consenting women received anal HPV DNA and cytological testing. Anal cytology smears were obtained from 410 women whose mean age was 22.5 +/- 2.5 years at the onset of the study. Sixteen women (3.9%) were found to have abnormal anal cytology: 4 women had low-grade squamous intraepithelial lesions (SILs) or condyloma; and 12 women had atypical cells of undetermined significance. Factors found to be significantly associated with abnormal anal cytology were a history of anal sex [odds ratio (OR), 6.90; 95% confidence interval (CI), 1.7-47.2], a history of cervical SILs (OR, 4.13; 95% CI, 1.3-14.9), and a current anal HPV infection (OR, 12.28; 95% CI, 3.9-43.5). The strong association between anal intercourse and the development of HPV-induced SILs supports the role of sexual transmission of HPV in anal SILs. Young women who had engaged in anal intercourse or had a history of cervical SILs were found to be at highest risk.

Adolescent↗
PubMed1998

The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women.

OBJECTIVES: The objectives of this study were to describe the early natural history of human papillomavirus (HPV) infection by examining a cohort of young women positive for an HPV test and to define within this cohort (1) the probability of HPV regression, (2) the risk of having a squamous intraepithelial lesion, and (3) factors that were associated with HPV regression. STUDY DESIGN: The study was a cohort analytic design. An inception cohort of 618 women positive for HPV participated. HPV testing, cytologic evaluation, and colposcopic evaluation were performed at 4-month intervals. HPV testing was characterized for two groups: low risk (five types rarely associated with cancers) and high risk (nine types most commonly associated with cancers). RESULTS: Estimates provided by Kaplan-Meier curves showed that approximately 70% of women were found to have HPV regression by 24 months. Women with low-risk HPV type infections were more likely to show HPV regression than were women with high-risk HPV type infections (log rank test p = 0.002). The relative risk for the development of high-grade squamous intraepithelial lesion (HSIL) was 14.1 (95% confidence interval: 2.3, 84.5) for women with at least three positive tests for high-risk HPV preceding the development of the HSIL compared with that for women with negative tests for high-risk HPV. However, 88% of women with persistent positive HPV tests have not had HSIL to date. No factors associated with high-risk HPV type regression were identified except for a negative association with an incident history of vulvar condyloma (relative risk = 0.5 [95% confidence interval: 0.3 to 0.8]). CONCLUSION: Most young women with a positive HPV test will become negative within a 24-month period. Persistent positive tests with oncogenic HPV types represented a significant risk for the development of HSIL. However, we found that most young women with persistent positive HPV tests did not have cytologically perceptible HSIL over a 2-year period. Factors thought to be associated with the development of HSIL were found not to be important in HPV regression.

Adolescent↗
PubMed1998

Managing sexually transmitted diseases in adolescents.

Control of sexually transmitted diseases (STDs) in adolescents is a primary responsibility of health care providers. Using the tools of history and physical examination, and drawing on the awareness of different stages of adolescent development, health care providers can define at-risk for STDs. This article discusses screening practices, disease control through reporting and preventive counseling, and treatment guidelines for common STD syndromes.

Adolescent↗
PubMed1998

The REACH Project of the Adolescent Medicine HIV/AIDS Research Network: design, methods, and selected characteristics of participants.

PURPOSE: To describe the Reaching for Excellence in Adolescent Care and Health (REACH) Project of the Adolescent Medicine Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Research Network, a unique collaborative effort to conceive and implement a research design intended to examine HIV pathogenesis, pubertal hormonal variation, and the effects of sexually transmitted disease comorbidity in HIV-infected youth to improve their health care. METHODS: This multidisciplinary team has drawn on basic science and clinical experience to produce a study design with relevant and feasible study aims and testable hypotheses. Particular attention has been paid to centralized training and quality control practices. Standardized measurements include direct and computer interviews, physical examination, laboratory analysis, and medical chart abstraction. The protocol has been approved by local institutional review boards. RESULTS: A highly standardized and quality control monitored protocol has been implemented at 16 sites throughout the United States collecting historical, observational, and laboratory data in a group of HIV-infected adolescents and HIV-negative controls. Preliminary data collected on subjects are consistent with published reports of the sociodemographic and clinical characteristics of the HIV epidemic in sexually active youth, thus supporting the integrity of the protocol development process. The study population is, for the most part, in older adolescence, predominantly minority and female, and with publicly financed or no health insurance. CONCLUSIONS: The REACH Project is positioned to address questions about the clinical course, immunologic profile, and viral dynamics in HIV-positive youth, and thus is able to inform drug development and management strategies for this understudied population.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The pediatrician and the sexually active adolescent. A primer for sexually transmitted diseases.

Sexual activity is a common practice among young adolescents, placing them at high risk for STDs, many of which have long-term consequences. Early diagnosis and treatment are essential to limit both the consequences and the spread of these infections. The clinician has a responsibility to the adolescent patient to recognize and treat these diseases. Using history and physical examination, the clinician should be able to determine an adolescent's risk for an STD, and, based on this risk, undertake the appropriate evaluations. Patient treatment, follow-up, and management of sex partners are then guided by the results of either presumptive or definitive diagnostic tests.

Adolescent↗
PubMed1997

Cytotoxic T lymphocyte responses to E6 and E7 proteins of human papillomavirus type 16: relationship to cervical intraepithelial neoplasia.

Cytotoxic T lymphocyte (CTL) responses to the human papillomavirus (HPV) type 16 E6 and E7 proteins were measured in 20 women with known HPV and cervical disease status. CTL assays were performed after stimulation with E6 or E7 fusion proteins using autologous B lymphoblastoid cells infected with vaccinia viruses expressing E6 or E7. CTL responses to E6 and E7 were detected in 6 (75%) of 8 and 5 (56%) of 9 HPV-16-positive women without cervical intraepithelial neoplasia (CIN), respectively. Responses to E6 or E7 were each detected in only 2 (29%) of 7 HPV-16-positive women with CIN. Responses to both antigens were found in 63% of women without CIN and 14% of those with CIN. CTL responses to E6 or E7 are more commonly detectable in HPV-16-positive women without CIN than in HPV-16-positive women with CIN, suggesting that CTL response may play a role in disease protection.

Adult↗
PubMed1997

Genital human papillomavirus infections: knowledge, perception of risk, and actual risk in a nonclinic population of young women.

The purpose of this study was to assess knowledge, beliefs, and attitudes about genital human papillomavirus (HPV) infections in a group of young women in a nonclinic setting and to examine the association between perception of risk and actual risk. One hundred ten women attending a state university participated in the study and were asked to complete a self-administered questionnaire about knowledge and perceptions of risk. They were then offered testing for the virus using a self-administered vaginal method. The mean age was 20 +/- 1.2 years. Ninety (82%) were sexually experienced (SE), with a mean number of lifetime partners of 5.1 +/- 4.3. The mean knowledge score was less than the 68th percentile, reflecting low levels of knowledge about genital HPV infections. The SE group had a higher knowledge score than the sexually inexperienced (p < .02), but there were no differences in knowledge between those who chose to be tested and those who refused testing. The majority of women attributed negative emotion to being hypothetically tested positive for HPV. Emotions selected by > 50% of the group included feeling scared, angry, guilty, anxious, confused, dirty, regretful, and panicky. A greater negative emotion score was associated with refusing HPV testing (p < .002). Of the SE women, 58% (51) perceived themselves at risk, and, of this group, 71% (36) agreed to be tested. Of the women who agreed to HPV testing, 36% who perceived themselves at risk and 35% who did not perceive themselves at risk were, in fact, positive for HPV (p = ns). The majority of women have little knowledge of HPV infections and have attributed many negative emotions associated with infectivity. These negative attributes appear to influence women's decision making concerning HPV testing. The risk of HPV infection in this nonclinic group was substantial, suggesting that even in a nonclinic group, the prevalence of HPV is quite high. Perception of risk was unrelated to actual risk (HPV positive test), reflecting the lack of self-identified risk.

Adolescent↗
PubMed1996

T-cell proliferative response to human papillomavirus type 16 peptides: relationship to cervical intraepithelial neoplasia.

The incidence of human papillomavirus (HPV)-related cervical intraepithelial neoplasia (CIN) and cervical cancer is increased with immunodeficiency, but the role of immune response, including cell-mediated immunity, in disease prevention is not well understood. In this study, T-cell proliferative responses to six synthetic peptides with predicted immunogenic determinants from the HPV-16 E4, E6, E7, and L1 open reading frames were analyzed in 22 sexually active women with new-onset CIN and 65 sexually active women without cervical disease, characterized by cytology, colposcopy, and HPV testing. T-cell proliferative responses were demonstrated to all six HPV-16 peptides. Although not statistically significant, rates of reactivity to E6 (24-45) were higher among sexually active women without disease (26%) than among women with current CIN (7%), as was the overall number of peptides stimulating a response. Women with CIN may not respond to selected HPV antigens as well as women without disease do.

Adult↗
PubMed1996

Genital HPV infections in children and adolescents.

Major differences in estrogen and progesterone levels and in vaginal/cervical cell types exist among children, adolescents, and adults, which may help explain the observed differences in the prevalence of HPV among these groups. Although sexual transmission occurs in both children and adolescents, the persistence of genital HPV in the neonate from maternal transmission is highly questionable. The discordances in HPV types between neonatal transmission studies and the studies in older children have yet to be explained. Neonatal infections seem to be predominantly types 16 and 18 and persist for short periods in the genital area. The majority of condylomatous lesions in children are HPV types 6 and 11. Acquisition of HPV during childhood and adolescence is not an immediate cause of severe morbidity. However, significant evidence suggests that early exposure not only hastens the development of anogenital cancers but may also increase the actual risk of cancer. Future studies should include large-scale longitudinal designs to test and follow neonates with careful attention to sexual abuse issues during the prospective period so that we may confidently diagnose and appropriately treat children with HPV infections. The role of age and immunity remains confusing, supporting the need for studies to examine cervical immunity more closely.

Adolescent↗
PubMed1995

Sexually-transmitted disease in female adolescents: effects of psychosocial factors and high risk behaviors.

BACKGROUND: Although previous studies have reported behavioral correlates of sexually-transmitted diseases (STDs) and psychosocial correlates of risky behavior, research has not examined the linkages between psychosocial attributes, behavioral patterns, and actual STD acquisition within the same adolescent sample. We examined the effects of five psychosocial factors on risky sexual behavior and substance use, and their direct and indirect effects on STD acquisition. METHODS: A multiethnic sample of 571 sexually-active female adolescents (ages 13-19 years) was recruited from family planning clinics. Subjects completed questionnaires prior to their gynecologic examination and STD testing. RESULTS: A multiethnic sample of 571 sexually-active female adolescents (ages 13-19 years) was recruited from family planning clinics. Subjects completed questionnaires prior to their gynecologic examination and STD testing. RESULTS: Female adolescents who were heavy substance users, who felt little control over their sexual behavior, and had a greater number of friends who engaged in risky sexual behavior were themselves more likely to engage in risky sexual behavior. Risky sexual behavior was associated with positive STD status. Subjects who used psychoactive substances during sex reported higher numbers of sexual partners and were more likely to have an STD. CONCLUSIONS: This research has identified possible causal paths by which psychosocial factors may influence specific behaviors that are predictive of STDs in adolescent females.

Adolescent↗
PubMed1995

A simple method for the propagation of cervical lymphocytes.

Local immune function is most likely a key influence in the establishment of human papillomavirus infections and its subsequent disease. Unfortunately, little information is known about local cervical immunity, and even less is known about human papillomavirus immunoreactivity. In addition, studies of local immunoreactivity have been hampered by the technical difficulty in obtaining cervical lymphocytes. The objective of the present study was to develop a simple method for the propagation of cervical lymphocytes from biopsy-size specimens. Cervical tissue was obtained from women undergoing a hysterectomy. Cervical samples measuring approximately 3 by 5 by 2 mm were minced and divided into two portions. One portion was digested by standard digestion methods and density gradient lymphocyte separation. The sample was then immunocharacterized for CD4 and CD8 cells by flow cytometry. The other portion was minced into 1-mm3 sections, and each section was placed into a separate well with tissue culture medium and interleukin-2. Lymphocyte counts and immunophenotypic analysis were performed after 18 to 20 days in culture. After 18 to 20 days in culture, the analysis demonstrated that this method of direct lymphocyte culture from a biopsy specimen yielded approximately 1 x 10(6) to 5 x 10(6) lymphocytes. Immunophenotypic studies of the digested sample at day 0 revealed CD4-to-CD8 ratios of between 0.7:1 and 3.5:1, and at days 18 to 20 they revealed ratios of between 2.3:1 and 98:1. In summary, we developed a simple technique for propagating cervical lymphocytes from small tissue samples for the study of the local immune response. Studies are under way to optimize lymphocyte growth and to preserve CD8 populations.

Adolescent↗
PubMed1995

Control of sexually transmitted diseases in adolescents: the clinician's role.

Sexually transmitted diseases common in the adolescent population are associated with significant acute morbidity, complications, and long-term sequelae. Clinicians have the opportunity to play a unique and important role in the control of STD rates among adolescents. Not only are clinicians in a position to routinely discuss healthy sexual development, decision making, and primary STD prevention, they are also in a position to effectively diagnose and manage STDs among both asymptomatic and symptomatic adolescents. Addressing issues related to sexuality and STDs in a consistent and repetitive manner during routine visits will likely increase physician proficiency in this important area of clinical care of adolescents, as well as increase adolescents' recognition of the clinician as a valuable resource.

Adolescent↗
PubMed1994

Detection of human papillomavirus type 16/18 DNA in cervicovaginal cells by fluorescence based in situ hybridization and automated image cytometry.

Automatic fluorescence image cytometry (AFIC) is a fast, sensitive, and reliable approach for screening slide-based clinical specimens. In this study, we applied AFIC to identify cancer-associated human papillomavirus (HPV) genotypes 16 and 18 in individual cells of cervical smears using a sensitive fluorescence based in situ hybridization (FISH) assay. HPV sequences were labeled by FISH and the cells imaged using an epi-fluorescence microscope coupled to a low-light color CCD camera. Before application to clinical specimens, AFIC was assessed using fluorescent calibration beads and cervical cancer cell lines containing known numbers of integrated HPV genomes per nucleus. Assessment showed that our AFIC had a linear response, was quantitatively accurate, and had the sensitivity to detect one HPV genome per nucleus. After acquisition of images, computer algorithms identified every cell nucleus (via a fluorescent DNA counterstain) and quantified the FISH signal per nucleus. AFIC was employed to screen 27 patient specimens for HPV 16/18, of which 12 were positive. The HPV status of the specimens positively correlated with the pathological diagnosis, and since AFIC automatically and correctly located every cell, it was possible to directly compare morphology and HPV status in the same cell. In conclusion, the combination of FISH and AFIC is a sensitive and quantitative method to detect high risk HPV sequences in cervical smears.

Algorithms↗
PubMed1994

Female adolescents at high, moderate, and low risk of exposure to HIV: differences in knowledge, beliefs, and behavior.

PURPOSE: To examine differences in the beliefs and behaviors of female adolescents at varying degrees of probable risk for HIV transmission. METHODS: A clinically-based, ethnically diverse sample of 696 sexually active female adolescents was recruited from urban and suburban general adolescent, family planning, and public health clinics. Subjects were categorized into four risk status groups on the basis of their history of IV drug use, sexually transmitted disease (STD), and probable risk of contact with an infected individual (living in a high-risk geographic location, sexual promiscuity, sex with male homo/bisexuals). RESULTS: Females in the highest risk group showed high rates of substance use, anal intercourse, and intentions to have future risky sexual partners. A second high-risk group reported high rates of STDs, inconsistent condom use, and less AIDS knowledge. CONCLUSION: Different subsets of higher risk adolescents may require different intervention strategies.

Adolescent↗
PubMed1993

Comparison between colposcopic, cytologic, and histologic findings in women positive and negative for human papillomavirus DNA.

Little is known about the role of detection of human papillomavirus (HPV) DNA in exfoliated cells of the cervix in aiding the colposcopic diagnosis of cervical lesions. The purpose of our study was to compare the colposcopic findings of young women who were positive and negative for HPV DNA. Eighty-four women aged 13-22 years attending family planning clinics were examined colposcopically with the aide of acetic acid and Lugol's solution and without knowledge of HPV DNA status. Lesions identified were given scores based on the severity of observed colposcopic changes. Samples for cytology and HPV DNA testing, which included types 6, 11, 16, 18, 31, 33, and 35, were obtained at the time of the examination. Biopsies were performed on women with significant lesions identified on examination or with cytology suggestive of neoplasia. Students t-test and chi 2 analysis were performed to compare colposcopic variables and HPV DNA type. Of the 84 women examined, 17 were positive for HPV DNA; 9 had type 16/18. The average length of sexual activity was 2.7 years. Women with HPV 16/18 had a mean of 1.7 lesions visible at colposcopy compared to 0.7 lesions visible in those negative for HPV 16/18 (this included HPV DNA negative women and women positive for HPV types 6, 11, 31, 33, and 35) (p < 0.001). Women who were positive for HPV 16/18 also had higher lesional scores than the HPV 16/18-negative group (3.4 versus 1.0, respectively, p < 0.001). All four women who had dysplasia either on cytology or histology were positive for type 16/18.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗