Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women.
OBJECTIVE
To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women.


METHODS
A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up.


RESULTS
Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15-2.64), and low CD4+ count (p=0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR]=3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR=6.12; 95% CI: 1.90-19.73).


CONCLUSIONS
Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.
Reimers
Laura L
LL
Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Belfer Educational Center, Room 501, Bronx, NY 10461, USA.
Sotardi
Susan
S
Daniel
David
D
Chiu
Lydia G
LG
Van Arsdale
Anne
A
Wieland
Daryl L
DL
Leider
Jason M
JM
Xue
Xiaonan
X
Strickler
Howard D
HD
Garry
David J
DJ
Goldberg
Gary L
GL
Einstein
Mark H
MH
D000328:Adult; D015331:Cohort Studies; D019092:Conization / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000601:surgery* / Q000821:virology*