Highly active antiretroviral therapy and cervical squamous intraepithelial lesions in human immunodeficiency virus-positive women.
BACKGROUND
Women infected with human immunodeficiency virus (HIV) have an increased risk of persistent squamous intraepithelial lesions (SILs) of the cervix. We assessed the association between use of highly active antiretroviral therapy (HAART) and regression of SIL in HIV-infected women enrolled in the Women's Interagency HIV Study, a large, multicenter, prospective cohort study.


METHODS
Of 2059 HIV-infected participants, 312 HIV-infected women had normal cervical cytology at baseline and were subsequently diagnosed during 7 years of follow-up with incident SIL. Pap smears, CD4+ T-cell counts, and information regarding use of HAART were obtained every 6 months. The outcome of interest was lesion regression, defined as two consecutive normal Pap smears 6 months apart. Incidence rates of SIL regression were computed among person-years at risk, both before and after HAART initiation. All statistical tests were two-sided.


RESULTS
Of 312 women, 141 had lesions that regressed to normal cytology, with a median time to regression of 2.7 years. Overall, the incidence of regression increased (P(trend) =.002) over time after HAART was introduced. At incident SIL, median CD4+ T-cell counts were lower in women whose lesions did not regress than in women whose lesions regressed (230 versus 336 cells/microL; P<.01). Before HAART was introduced, the rate of lesion regression was 0.0% (95% confidence interval [CI' = 0.0% to 2.4%). After HAART was introduced, the rate was 12.5% (95% CI = 9.9% to 15.1%) and was related to post-HAART CD4+ T-cell counts (P(trend) =.002).


CONCLUSIONS
HAART use was associated with increased regression of SIL among HIV-infected women, and among women who used HAART, increased CD4+ T-cell counts were associated with a greater likelihood of regression. However, the majority of cervical lesions among HIV-infected women, even among individuals who used HAART, did not regress to normal.
Ahdieh-Grant
Linda
L
Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Rm. E-7014, Baltimore, MD 21205, USA. lahdieh@jhmi.edu
Li
Rui
R
Levine
Alexandra M
AM
Massad
L Stewart
LS
Strickler
Howard D
HD
Minkoff
Howard
H
Moxley
Michael
M
Palefsky
Joel
J
Sacks
Henry
H
Burk
Robert D
RD
Gange
Stephen J
SJ
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015496:CD4-Positive T-Lymphocytes; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D018655:Lymphocyte Count; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D011446:Prospective Studies; D012107:Research Design; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears