title: Natural history of grade 1 cervical intraepithelial neoplasia in women with human immunodeficiency virus.
abstract: OBJECTIVE
  We sought to estimate rates of progression and regression of grade 1 cervical intraepithelial neoplasia (CIN 1) among women with human immunodeficiency virus (HIV).
  
  
  METHODS
  In a multicenter prospective cohort study, HIV-seropositive and HIV-seronegative women were evaluated colposcopically after receiving an abnormal cytology test result between November 1994 and September 2002. Women with CIN 1 were included, except those who had undergone hysterectomy, cervical therapy, or had CIN 2-3 or cervical cancer. Those women who were included were followed cytologically twice yearly, with colposcopy repeated for atypia or worse.
  
  
  RESULTS
  We followed 223 women with CIN 1 (202 HIV seropositive and 21 HIV seronegative) for a mean of 3.3 person-years. Progression occurred in 8 HIV-seropositive women (incidence density, 1.2/100 person-years; 95% confidence interval [CI] 0.5-2.4/100 person-years) and in no HIV seronegative women. Regression occurred in 66 (33%) HIV-seropositive women (13/100 person-years, 95% CI 10-16/100 person-years) versus 14 (67%) seronegative women (32/100 person-years, relative risk 0.40, 95% CI 0.25-0.66; P < .001). In multivariate analysis, regression was associated with human papillomavirus (HPV) detection (hazard ratio [HR] for low risk 0.28, 95% CI 0.13-0.61, P = .001; and for high-risk 0.34, 95% CI 0.20-0.55, P < .001 versus no HPV detected) and Hispanic ethnicity (HR 0.48, 95% CI 0.230.98; P = .04); HIV serostatus was only marginally linked to regression (HR 0.52, 95% CI 0.27-1.03; P = .06), but seropositive women were less likely to regress when analysis was limited to 146 women with HPV detected at CIN 1 diagnosis (HR 0.18, 95% CI 0.05-0.62; P = .006).
  
  
  CONCLUSIONS
  Grade 1 cervical intraepithelial neoplasia infrequently progresses in women with HIV. Thus, observation appears safe absent other indications for treatment.
  
  
  METHODS
  II-1.
authors.affiliation: Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9640, USA. LSMASSAD@ameritech.net
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Teresa
authors.initials: T
authors.lastname: Darragh
authors.forename: Alexandra
authors.initials: A
authors.lastname: Levine
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Michael
authors.initials: M
authors.lastname: Moxley
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Passaro
mesh_terms: D000328:Adult; D003127:Colposcopy; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*