Effect of highly active antiretroviral therapy (HAART) and menopause on risk of progression of cervical dysplasia in human immune-deficiency virus- (HIV-) infected women.
BACKGROUND
More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions (SILs) on these women.


METHODS
To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis.


RESULTS
Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen or no regimen (CI: 0.33-0.70, P = 0.0001). A greater increase of CD4(+) cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11-2.62, P < 0.0001), adjusting for HIV medications, CD4(+) count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking.


CONCLUSIONS
HAART had a positive long-term effect on the progression to SILs. However, being younger and menopausal increases the risk of progression.
Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, P.O. Box 689 601, Elmwood Avenue, Rochester, NY 14642, USA.
Suk Chul
SC
Kim
Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Susan
S
Messing
Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Krupa
K
Shah
Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, P.O. Box 689 601, Elmwood Avenue, Rochester, NY 14642, USA.
Amneris E
AE
Luque
D017088:AIDS-Related Opportunistic Infections; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*