title: Increased regression and decreased incidence of human papillomavirus-related cervical lesions among HIV-infected women on HAART.
abstract: OBJECTIVE
  To determine the impact of HAART on incidence, regression, and progression of cytopathological abnormalities in HIV-infected women.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  HIV-infected women (N=1123) from Soweto, South Africa underwent serial cervical smears that were analyzed and reported using the Bethesda System. The results of HAART and non-HAART users were compared using two statistical approaches: a survival analysis assessing risk of incident smear abnormality among women with baseline normal smear results; and analysis with marginal models assessing for an association between HAART use and likelihood of regression/progression in consecutive smears.
  
  
  RESULTS
  After multivariate survival analysis, women using HAART with a normal baseline smear were 38% less likely to have an incident smear abnormality during follow-up than nonusers [confidence interval (CI) 0.42-0.91; P=0.01]. Multivariate marginal models analysis identified a significantly increased likelihood (odds ratio 2.61; CI 1.75-3.89; P<0.0001) of regression of cervical lesions among women on HAART.
  
  
  CONCLUSIONS
  Our large prospective cohort study adds significant weight to the side of the balance of clinical research supporting the positive impact of HAART on the natural history of human papillomavirus-related cervical disease in HIV-infected women.
authors.affiliation: Department of Emergency Medicine, University of Rochester, Rochester, NY 14642, USA. david_adler@urmc.rochester.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Adler
authors.forename: Lisa
authors.initials: L
authors.lastname: Kakinami
authors.forename: Tebogo
authors.initials: T
authors.lastname: Modisenyane
authors.forename: Nkeko
authors.initials: N
authors.lastname: Tshabangu
authors.forename: Lerato
authors.initials: L
authors.lastname: Mohapi
authors.forename: Guy
authors.initials: G
authors.lastname: De Bruyn
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
authors.forename: Tanvier
authors.initials: T
authors.lastname: Omar
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D052685:Alphapapillomavirus; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D015999:Multivariate Analysis; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology