The effect of highly active antiretroviral therapy on human papillomavirus clearance and cervical cytology.
OBJECTIVE
To examine the association of highly active antiretroviral therapy (HAART) with human papillomavirus (HPV) clearance and progression or regression of cervical cytological abnormalities in women with human immunodeficiency virus (HIV).


METHODS
Five hundred thirty-seven women with HIV participating in the HIV Epidemiology Research Study, an observational, multisite cohort study, were evaluated semiannually from 1996 to 2000. Cervical Pap tests were collected for cervical cytology. Testing for HPV was conducted by polymerase chain reaction. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals (CIs). Number needed to treat (NNT) at 2 years was calculated for HAART.


RESULTS
Among women with cervical squamous intraepithelial lesions, HAART was associated with an increased likelihood of HPV clearance (hazard ratio 4.5, 95% CI 1.2-16.3, NNT 22.4). Use of HAART was not associated with an increased likelihood of HPV clearance among women with normal cervical cytology (hazard ratio 1.7, 95% CI 0.9-3.1, NNT 6.5) or atypical squamous cells of undetermined significance cytology (hazard ratio 1.0, 95% CI 0.4-2.5, NNT 174.0). Use of HAART was not significantly associated with an increased likelihood of cervical cytologic regression (hazard ratio 1.3, 95% CI 1.0-1.7, NNT 10.9) or cervical cytologic progression (hazard ratio 0.7, 95% CI 0.6-1.0, NNT 12.8).


CONCLUSIONS
Among women with preexisting abnormal cervical cytology, HAART was associated with enhanced HPV clearance but not with Pap test regression. Close monitoring of women with HIV for cervical cytologic abnormalities, regardless of HAART treatment status, is warranted.


METHODS
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Paramsothy
Pangaja
P
From CONRAD, Arlington, Virginia; the Centers for Disease Control and Prevention, Atlanta, Georgia; Wayne State University School of Medicine, Detroit, Michigan; Mount Sinai School of Medicine, New York, New York; Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Brown Medical School, Providence, Rhode Island; and the Fred Hutchinson Cancer Research Center, Seattle, Washington.
Jamieson
Denise J
DJ
Heilig
Charles M
CM
Schuman
Paula C
PC
Klein
Robert S
RS
Shah
Keerti V
KV
Rompalo
Anne M
AM
Cu-Uvin
Susan
S
Duerr
Ann
A
D017088:AIDS-Related Opportunistic Infections / Q000821:virology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000821:virology*; D012074:Remission Induction; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000473:pathology / Q000821:virology*