title: Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-positive women.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center and State University of New York Downstate, Brooklyn, NY 11219, USA. hminkoff@maimonidesmed.org
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhong
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Wright
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents