title: Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: a prospective cohort.
abstract: OBJECTIVE
  To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system. Those with high-grade lesions or worse were referred for colposcopy. Progression analyses included women with at least two smears at least 5.5 months apart. Hazard ratios were used to ascertain predictors of progression.
  
  
  RESULTS
  Two thousand, three hundred and twenty-five women had a baseline smear; their median age and CD4 cell count was 32 years and 312 cells/μl, respectively; 17% were taking highly active antiretroviral therapy (HAART); 62, 20 and 14% had normal, low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), respectively. Of those with baseline normal or LSIL smears, 1074 had another smear; progression from normal to LSIL was 9.6/100 person-years (95% CI 8.3-11.1) and progression from normal or LSIL to HSIL was 4.6/100 person-years (95% CI 3.9-5.5). Of 225 women with LSIL at baseline and at least one subsequent smear at least 11.5 months later, 44.0% regressed to normal (21.2/100 person-years (95% CI 17.5-25.7)). Multivariate models suggested increasing risk for progression in women with CD4 cell count below 500 cells/μl and HAART may reduce the risk of progression [adjusted hazard ratio (aHR) 0.72 (0.52-0.99)].
  
  
  CONCLUSIONS
  HIV-infected women have high rates of prevalent and incident HSIL and LSIL with relatively low risk of regression to normal from LSIL. HAART appears to protect against progression. Our findings suggest cervical screening intervals should be less than 10 years - irrespective of age in women with CD4 cell counts below 500 cells/μl.
authors.affiliation: Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tanvier
authors.initials: T
authors.lastname: Omar
authors.forename: Sheree
authors.initials: S
authors.lastname: Schwartz
authors.forename: Colleen
authors.initials: C
authors.lastname: Hanrahan
authors.forename: Tebogo
authors.initials: T
authors.lastname: Modisenyane
authors.forename: Nkeko
authors.initials: N
authors.lastname: Tshabangu
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Golub
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
authors.forename: Glenda E
authors.initials: GE
authors.lastname: Gray
authors.forename: Lerato
authors.initials: L
authors.lastname: Mohapi
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D011230:Precancerous Conditions / Q000175:diagnosis; D011446:Prospective Studies; D012367:RNA, Viral; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
chemical_list: D012367:RNA, Viral