Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-positive women.
BACKGROUND
The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression).


METHODS
Human immunodeficiency virus (HIV)-positive women (N = 286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed > or = 95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group).


RESULTS
HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44-0.81]; P = .001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30-0.82]; P = .006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07-5.18]; P = .03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence.


CONCLUSIONS
Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.
Minkoff
Howard
H
Department of Obstetrics and Gynecology, Maimonides Medical Center and State University of New York Downstate, Brooklyn, NY 11219, USA. hminkoff@maimonidesmed.org
Zhong
Ye
Y
Burk
Robert D
RD
Palefsky
Joel M
JM
Xue
Xiaonan
X
Watts
D Heather
DH
Levine
Alexandra M
AM
Wright
Rodney L
RL
Colie
Christine
C
D'Souza
Gypsyamber
G
Massad
L Stewart
LS
Strickler
Howard D
HD
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology* / Q000821:virology; D027383:Papillomaviridae / Q000187:drug effects; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000821:virology; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents