title: Impact of timing of antiretroviral therapy initiation on survival of cervical squamous intraepithelial lesions: a cohort analysis from South Africa.
abstract: To determine factors that influence excision treatment outcome and recurrence of cervical squamous intraepithelial lesions (SIL) in women living with HIV infection, we analysed 1848 women who underwent excision treatment of cervical SIL at Tygerberg Hospital, Cape Town, South Africa. We compared treatment failure defined as presence of cervical intraepithelial neoplasia (CIN) I (presence of CIN I or higher at first follow-up after excision treatment) and post-excision recurrence of lesions (at one year or later) between women of HIV-positive, -negative or unknown status and examined factors associated with excision treatment outcome and recurrence. HIV-infected women experienced higher treatment failure than uninfected women (53.8% versus 26.9%, P < 0.001). At treatment failure, more HIV-infected women had low-grade squamous intraepithelial lesion (LSIL) compared with uninfected women (64.9% versus 37.3%, P < 0.001). Treatment failure did not differ with the type of excision used in HIV-infected women. HIV-infected women were more likely to experience recurrence of lesions after excision treatment than uninfected women (hazard ratio 1.95, 95% confidence interval [CI] 1.59-2.39; P < 0.001). Antiretroviral therapy (ART) initiated before excision biopsy had a strong protective effect against recurrence (hazard ratio 0.70, 95% CI 0.55-0.89; P = 0.006). Our data suggest that women with cervical SIL initiated on ART earlier may be expected to have better long-term excision treatment outcome. Close follow-up should be maintained after cervical excision treatment, especially in a setting of high HIV prevalence.
authors.affiliation: Department of Medicine and Centre for Infectious Diseases (CID), Stellenbosch University, Cape Town, South Africa. mdz@iburst.co.za
authors.forename: M D
authors.initials: MD
authors.lastname: Zeier
authors.forename: J B
authors.initials: JB
authors.lastname: Nachega
authors.forename: F H
authors.initials: FH
authors.lastname: Van Der Merwe
authors.forename: I
authors.initials: I
authors.lastname: Eshun-Wilson
authors.forename: M
authors.initials: M
authors.lastname: Van Schalkwyk
authors.forename: M
authors.initials: M
authors.lastname: La Grange
authors.forename: D
authors.initials: D
authors.lastname: Mason
authors.forename: M
authors.initials: M
authors.lastname: Louw
authors.forename: M H
authors.initials: MH
authors.lastname: Botha
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D012008:Recurrence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000601:surgery* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000150:complications* / Q000453:epidemiology / Q000821:virology*
chemical_list: D044966:Anti-Retroviral Agents