The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women

AIDS. 2001 Nov 9;15(16):2157-64. doi: 10.1097/00002030-200111090-00011.

Abstract

Objective: Cervical intraepithelial neoplasia (CIN), a common condition among HIV-infected women, has been linked to HIV load and immune status. Highly active antiretroviral therapy (HAART) improves immunologic and virologic status. This study was undertaken to determine the relationship between HAART use and CIN.

Design: Cohort study. The Women's Interagency HIV Study (WIHS) in five cities in the USA (Bronx/Manhattan, New York; Brooklyn, New York; Chicago, Illinois; Los Angeles, California; San Francisco Bay area, California; Washington, District of Columbia).

Methods: HIV-infected women were followed every 6 months with Papanicolaou smears and cervicovaginal lavage for human papillomavirus (HPV) DNA testing. To characterize exposures that changed over time and to capture the dynamic nature of cytologic changes, Papanicolaou smear findings from each participant's consecutive visits were defined as a pair. We determined the proportion of all pairs that exhibited either regression or progression, according to HAART exposure, HPV results and Papanicolaou smear status. As participants could contribute multiple pairs, inferences were based on robust methods to adjust for correlated observations.

Results: Women with persistent HPV infection were more likely to have progression of their lesions. After adjustment for CD4 cell count and Papanicolaou smear status, women on HAART were 40% (95% confidence interval, 4-81%) more likely to demonstrate regression and less likely (odds ratio, 0.68; 95% confidence interval, 0.52-0.88) to demonstrate progression

Conclusions: HAART altered the course of HPV disease in HIV-infected women, reducing progression and increasing regression. As HPV disease is a common sex-specific manifestation of HIV disease this effect of HAART would be a major additional benefit from this modality of therapy.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Cervical Intraepithelial Neoplasia / complications
  • Cervical Intraepithelial Neoplasia / drug therapy*
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervix Uteri / cytology
  • Cervix Uteri / pathology*
  • Cervix Uteri / virology
  • Cohort Studies
  • DNA, Viral / analysis
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • HIV-1 / physiology
  • Humans
  • Papanicolaou Test
  • Papillomaviridae / genetics
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / drug therapy*
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology
  • Treatment Outcome
  • Tumor Virus Infections / complications
  • Tumor Virus Infections / drug therapy*
  • Tumor Virus Infections / pathology
  • Tumor Virus Infections / virology
  • Vaginal Smears

Substances

  • DNA, Viral