title: Cervical intra-epithelial neoplasia in HIV-positive women after excision of transformation zone - does the grade change?
abstract: OBJECTIVE
  After previously reporting the presence of disease by cytology findings after treatment for cervical intra-epithelial neoplasia (CIN) in 64.6% of HIV-infected women and in 13.0% of HIV-negative women, we aimed to determine the severity of cytological disease after treatment in HIV-infected women.
  
  
  METHODS
  We studied HIV-infected (N=571) women treated at the Colposcopy Clinic at Chris Hani Baragwanath Hospital, Gauteng, between April 2003 and December 2006. We compared the initial histology results with Pap smears ≥6 months later, and evaluated factors associated with reduction in the grade of disease.
  
  
  RESULTS
  Mean age was 36.68 (SD+7.33) years; mean parity was 2 (SD+1.46); mean CD4+ count was 242.70 cells/mm3 (SD+187.56); 262 (45.80%) were receiving antiretroviral treatment. Persistent disease was detected on the repeat Pap smear in 199 (65.03%); of these, 223 (72.88%) were of a lesser grade than in the original histology results. Of the 152 with histologically confirmed CIN3, 67 (44.08%) had improved to a lesser grade, and 54 (44.63%) had normal cytology results. Among the latter two subject groups (n=141) who had CIN2 histologically, 91 (64.53%) had improved, 29 (20.57%) remained unchanged, and 20 (14.88%) had CIN3; 13 (4.25%) patients with CIN1 returned for follow-up; 11 (84.62%) of these had normal Pap smears and 2 (15.38%) had CIN3.
  
  
  CONCLUSIONS
  Recurrences were of a lesser degree than initial histology results. This reduction in the grade of disease was related to CD4+ count, complete excision and parity. Antiretroviral therapy use did not improve outcome, perhaps owing to low initial CD4 counts.
authors.affiliation: Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Firdousi
authors.initials: F
authors.lastname: Kabir
authors.forename: Cyril
authors.initials: C
authors.lastname: van Gelderen
authors.forename: James
authors.initials: J
authors.lastname: McIntyre
authors.forename: Pam
authors.initials: P
authors.lastname: Michelow
authors.forename: Dianne
authors.initials: D
authors.lastname: Turton
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Adam
mesh_terms: D000328:Adult; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D012189:Retrospective Studies; D013019:South Africa; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery / Q000821:virology*