title: Progression and persistence of low-grade cervical squamous intraepithelial lesions in women living with human immunodeficiency virus.
abstract: OBJECTIVE
  This study aimed to investigate the progression and persistence of low-grade squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)-infected women.
  
  
  METHODS
  Study participants for this retrospective cohort study were 1,720 women who had LSIL as their first abnormal Pap smear. A comparison of the survival of LSIL without progression to high-grade SIL as progression-free time and the survival of SIL without clearance of the lesion as persistence of SIL was done for women of HIV-positive, HIV-negative, or unknown status using the Kaplan-Meier method. Multivariable Cox proportional hazards regression model was applied to identify independent risk factors for disease progression or persistence.
  
  
  RESULTS
  We found progression of LSIL not different between HIV groups but that persistence occurred more in HIV-positive women (63.8% vs 35.0%, p < .001). For the HIV group, antiretroviral therapy that was started before the first LSIL was associated with decreased risk for progression compared with no antiretroviral therapy (hazard ratio = 0.66, 95% CI = 0.54-0.81, p < .001). Antiretroviral therapy also improved clearance when corrected for excision treatment and age (hazard ratio = 1.71, 95% CI = 1.29-2.27, p < .001). Excision of LSIL reduced the risk of progression. In HIV-negative women, progression was reduced from 54.7% to 0.0% (p < .001), and from 46.9% to 6.4% in HIV-positive women (p < .001). Excision also reduced persistence in HIV-negative women from 39.5% to 7.1% (p = .001), but for HIV-positive women, the effect was smaller (from 66.3% to 45.5%, p < .001).
  
  
  CONCLUSIONS
  Antiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.
authors.affiliation: Department of Medicine, Stellenbosch University, Cape Town, South Africa. mdz@sun.ac.za
authors.forename: Michèle Desiré
authors.initials: MD
authors.lastname: Zeier
authors.forename: Matthys Hendrik
authors.initials: MH
authors.lastname: Botha
authors.forename: Frederick Haynes
authors.initials: FH
authors.lastname: van der Merwe
authors.forename: Ingrid
authors.initials: I
authors.lastname: Eshun-Wilson
authors.forename: Marije
authors.initials: M
authors.lastname: van Schalkwyk
authors.forename: Marina
authors.initials: M
authors.lastname: la Grange
authors.forename: Deidre
authors.initials: D
authors.lastname: Mason
authors.forename: Mercia
authors.initials: M
authors.lastname: Louw
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D018709:Statistics, Nonparametric; D015996:Survival Rate; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy
chemical_list: D044966:Anti-Retroviral Agents