Management and outcome of cervical intraepithelial neoplasia lesions: a study of matched cases according to HIV status.
OBJECTIVE
To assess whether adequate strategies are used for the management of cervical intraepithelial neoplasia (CIN) in HIV-positive patients.


METHODS



METHODS
Retrospective study in a HIV reference university hospital. Sixty-eight HIV-infected patients who had undergone a cervical biopsy between January 1995 and March 2002 were matched for CIN and age with HIV-negative patients.


RESULTS
Assess mean of treatment strategy. Assess mean of treatment failure by immediate follow-up PAP smear and recurrence rate by long-term follow-up smears.


RESULTS
Both groups of patients received similar treatments for their cervical anomalies. HIV-positive women were two times more likely to have involved margins after conisation than HIV-negative women (P < 0.01). Globally, two thirds of HIV-negative patients had a first follow-up PAP smear that was normal, while this was the case in only one third of HIV-positive women. These proportions were also significantly different after conisation (P < 0.01). The same differences were also observed after sustained follow-up. HIV-infected women who showed a recurrence of dysplasia were more likely to have failed antiviral therapy (9/44) than those without any recurrence (7/12) (P < 0.01).


CONCLUSIONS
Higher rates of recurrence were observed among HIV-infected women, indicating that CIN management is more difficult and may require adapted guidelines in HIV-positive patients. In HIV-infected patients, an association was found between the absence of recurrence and a viral response to antiviral therapy.
Gilles
Christine
C
Department of Obstetrics and Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, 322 rue Haute, 1000 Brussels, Belgium.
Manigart
Yannick
Y
Konopnicki
Deborah
D
Barlow
Patricia
P
Rozenberg
Serge
S
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery / Q000628:therapy* / Q000821:virology*; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000601:surgery / Q000628:therapy* / Q000821:virology*