title: Recurrence of cervical intraepithelial neoplasia in human immunodeficiency virus-infected women treated by means of electrosurgical excision of the transformation zone (LLETZ) in Rio de Janeiro, Brazil.
abstract: OBJECTIVE
  Human immunodeficiency virus (HIV)-infected women have higher incidence, prevalence, persistence and recurrence of pre-invasive cervical lesions (CIN II or III). The aim here was to investigate the risk of recurrence of CIN II/III among HIV-infected women (HIV+) and uninfected women in a cohort treated by means of large-loop excision of the transformation zone (LLETZ).
  
  
  METHODS
  Cohort study conducted at Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz).
  
  
  METHODS
  60 HIV+ and 209 HIV-negative patients were included in a cohort for follow-up after undergoing LLETZ to treat CIN II/III. A histopathological diagnosis of CIN II/III during the follow-up was taken to constitute recurrence. The following possible confounding variables were assessed: age at treatment and at end of follow-up; histological grade of intraepithelial disease treated; surgical margin involvement; adequacy of colposcopy during the follow-up; CD4+ lymphocyte count; HIV viral load; and type of antiretroviral therapy.
  
  
  RESULTS
  Among the 60 HIV+ women, six showed recurrent disease during the follow-up. However, among the 209 HIV-negative women, seven showed a new precursor lesion. The relative risk of disease recurrence in the HIV+ women was 4.21 (95% CI = 1.42 to 12.43). The Kaplan-Meyer curve showed that the risk of recurrence was significantly higher among HIV+ women (log-rank test: P = 0.0111).
  
  
  CONCLUSIONS
  The HIV+ women in our cohort presented a risk of CIN II/III recurrence at least 42% higher than among the HIV-negative women. These patients should form part of a rigorous screening and follow-up protocol for identification and appropriate treatment of cervical cancer precursor lesions.
authors.affiliation: Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Colposcopy Sector, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Russomano
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Bruno Reis
authors.initials: BR
authors.lastname: Paz
authors.affiliation: Department of Gynecology, IFF, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Maria José de
authors.initials: MJ
authors.lastname: Camargo
authors.affiliation: Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Clinical Trials Unit, Rio de Janeiro, Brazil.
authors.forename: Beatriz Gilda Jegerhorn
authors.initials: BG
authors.lastname: Grinstejn
authors.affiliation: Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Clinical Trials Unit, Rio de Janeiro, Brazil.
authors.forename: Ruth Khalili
authors.initials: RK
authors.lastname: Friedman
authors.affiliation: Department of Pathological Anatomy, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Maria Aparecida Pereira
authors.initials: MA
authors.lastname: Tristao
authors.affiliation: Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil.
authors.forename: Caroline Alves
authors.initials: CA
authors.lastname: Oliveira
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D009364:Neoplasm Recurrence, Local; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000601:surgery*