Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa.
BACKGROUND
The risk of squamous intra-epithelial lesions (SIL) is higher in HIV-positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART), their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV-positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV-positive women in South Africa.


METHODS
A prospective observational study of HIV-seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs), adjusted for age, CD4 count and other potential confounders.


RESULTS
Median follow-up time was 445 days (inter-quartile range 383, 671). The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL) 12.7, 19.9) per 100 person-years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1) per 100 person-years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR=0.55 (95% CL 0.37, 0.80). Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure.


CONCLUSIONS
HAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV-positive women.
Faculty of Health Science Center, Department of Medicine, Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa. cindy.firnhaber@righttocare.org
Cynthia
C
Firnhaber
Daniel
D
Westreich
Doreen
D
Schulze
Sophie
S
Williams
Maureen
M
Siminya
Pam
P
Michelow
Simon
S
Levin
Mark
M
Faesen
Jennifer S
JS
Smith
D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D065006:Papanicolaou Test; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D014626:Vaginal Smears