title: Predictors of persistent cytologic abnormalities after treatment of cervical intraepithelial neoplasia in Soweto, South Africa: a cohort study in a HIV high prevalence population.
abstract: BACKGROUND
  In the presence of both HIV infection and cervical intraepithelial neoplasia (CIN), the risk of cancer development despite treatment may be greater. We investigated clinical predictors of persistent cytological abnormalities in women who had had a large loop excision of the transformation zone (LLETZ).
  
  
  METHODS
  Women with high grade squamous intraepithelial lesions or worse (HSIL), less severe abnormalities which persisted and any abnormality in women who are HIV-infected, were referred to the colposcopy clinic. HIV infection was ascertained by self-report. A LLETZ was performed on all patients with HSIL or higher on Papanicolaou (Pap) smear or colposcopy, LSIL or higher in patients who are HIV-infected, where the colposcopy is inadequate, and when there was a discrepancy between colposcopy and cytology by one or more grades. Women with abnormal follow-up smears were compared to those with normal smears. We examined the association between abnormal follow-up smears and demographic and clinical predictors using logistic regression
  
  
  RESULTS
  The median time between LLETZ and first follow-up Pap smear was rather short at 122 days. Persistent cytological abnormalities occurred in 49% of our patients after LLETZ. Predictors of persistence included the presence of disease at both margins and HIV infection. Among the latter, disease at the excision margins and CD4+ cell count were important predictors. In these women, disease at the endocervical margin, both margins, and disease only at the ectocervical margin were associated with increased odds of persistent abnormalities on follow-up cervical smear.
  
  
  CONCLUSIONS
  We showed extremely high risk of cytological abnormality at follow-up after treatment more so in patients with incomplete excision and in the presence of immunocompromise. It remains uncertain whether recurrent CIN is a surrogate marker for invasive cervical cancer.
authors.affiliation: Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa. yasminadam@gmail.com
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Adam
authors.forename: Cyril J
authors.initials: CJ
authors.lastname: van Gelderen
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
authors.forename: Diane A
authors.initials: DA
authors.lastname: Turton
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
mesh_terms: D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D015995:Prevalence; D012044:Regression Analysis; D012306:Risk; D013019:South Africa; D016896:Treatment Outcome; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology*