title: Evaluation of HIV and highly active antiretroviral therapy on the natural history of human papillomavirus infection and cervical cytopathologic findings in HIV-positive and high-risk HIV-negative women.
abstract: BACKGROUND
  The Canadian Women's HIV Study (CWHS) enrolled human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women in a longitudinal cohort. This analysis considered the effects of HIV and highly active antiretroviral therapy (HAART) on HPV persistence and cervical squamous intraepithelial lesions (SILs).
  
  
  METHODS
  Longitudinal cytopathologic and HPV DNA results were analyzed using multistate models. States of cervical SIL were defined as absent, present, and treatment; HPV states were defined as negative or positive. Demographic variables and markers of sexual activity were considered predictors. Results were calculated on the basis of transition probabilities and reported as hazard ratios (HRs).
  
  
  RESULTS
  The CWHS followed 750 HIV-positive and 323 HIV-negative women during 1993-2002. A total of 467 and 456 women were included in the longitudinal cervical cytopathologic and HPV DNA analyses, respectively. HIV-positive women had increased prevalence (46.6% vs 28.7%; P < .0001), increased acquisition (HR, 2.3; P = .03), and decreased clearance (HR, 0.4; P < .001) of oncogenic HPV as compared to HIV-negative women. Oncogenic HPV infection predicted progression of cervical dysplasia from normal to abnormal SIL (HR, 2.8; P = .002). Among HIV-positive participants, HAART increased the likelihood of regression (from present to absent) of cervical SIL (HR, 3.3; P = .02) and increased the clearance of oncogenic HPV types other than HPV-16 or HPV-18 (HR, 2.2; P = .01).
  
  
  CONCLUSIONS
  This analysis demonstrated beneficial effects of HAART on cervical SIL in HIV-positive women.
authors.affiliation: Toronto General Research Institute, University Health Network, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Blitz
authors.forename: Joanna
authors.initials: J
authors.lastname: Baxter
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.forename: Fiona
authors.initials: F
authors.lastname: Smaill
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
authors.forename: Catherine
authors.initials: C
authors.lastname: Hankins
authors.forename: Deborah
authors.initials: D
authors.lastname: Money
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002170:Canada / Q000453:epidemiology; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D015331:Cohort Studies; D003584:Cytological Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology*; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D019562:Viral Load; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology*
keywords: HAART; HIV; HPV; cervical cancer; cervical dysplasia; cervical squamous intraepithelial lesion; women