Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV.
OBJECTIVE
To describe outcomes after treatment of cervical intraepithelial neoplasia (CIN) in women with HIV.


METHODS
Women in two prospective cohort studies, the Women's Interagency HIV Study (WIHS) and the HIV Epidemiology Research Study (HERS), were followed every 6 months after treatment of CIN using human papillomavirus (HPV) testing and cytology with colposcopy as indicated. Identification of CIN or a squamous intraepithelial lesion (SIL) within 6 months was defined as treatment failure and later disease as recurrence.


RESULTS
Follow-up was available for 170 HIV-seropositive and 15 HIV-seronegative women. Treatment failed in 84 (45%) women (79 HIV seropositive and 5 HIV seronegative). Failure was more likely in women with lower CD4 counts (CD4 < 200 cells/microL: odds ratio [OR] = 2.96; 95% CI = 1.4-6.2) and detectable HPV DNA (OR 8.20; 95% CI = 1.8-37.4; p = .01). After successful treatment, recurrence-free probabilities at 1,2, 3, and 5 years were .79, .64, .49, and .34, respectively. HIV-seronegative women were less likely to recur than HIV-seropositive women (p = .03). In multivariable analysis of HIV-positive women, recurrence was more likely among women treated for CIN 2,3 (hazard ratio [HR] = 2.4; 95% CI = 1.4-4.8), those with CD4 count of less than 200 cells/microL (HR = 2.9; 95% CI = 1.3-6.5) and those with HPV after treatment (HR 2.9; 95% CI = 1.4-6.1); oncogenic HPV was more strongly associated with recurrence than nononcogenic HPV (p(trend) = .009). Most failures and recurrences were low grade, but one adenocarcinoma was diagnosed 4.2 years after therapy for CIN 1.


CONCLUSIONS
Treatment failure and recurrence are common in women with HIV but are usually low grade.
Massad
L Stewart
LS
Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL 62794-9640, USA. lsmassad@ameritech.net
Fazzari
Melissa J
MJ
Anastos
Kathryn
K
Klein
Robert S
RS
Minkoff
Howard
H
Jamieson
Denise J
DJ
Duerr
Ann
A
Celentano
David
D
Gange
Stephen
S
Cu-Uvin
Susan
S
Young
Mary
M
Watts
D Heather
DH
Levine
Alexandra M
AM
Schuman
Paula
P
Harris
Tiffany G
TG
Strickler
Howard D
HD
D000328:Adult; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology; D015331:Cohort Studies; D003127:Colposcopy; D004279:DNA, Viral / Q000302:isolation & purification; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016017:Odds Ratio; D027383:Papillomaviridae / Q000235:genetics; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology
D004279:DNA, Viral