Management and Outcome of Cervical Intraepithelial Neoplasia Lesions: A Study of Matched Cases According to HIV Status

Gynecol Oncol. 2005 Jan;96(1):112-8. doi: 10.1016/j.ygyno.2004.10.003.

Abstract

Objectives: To assess whether adequate strategies are used for the management of cervical intraepithelial neoplasia (CIN) in HIV-positive patients.

Setting: Retrospective study in a HIV reference university hospital. Sixty-eight HIV-infected patients who had undergone a cervical biopsy between January 1995 and March 2002 were matched for CIN and age with HIV-negative patients.

Outcome: Assess mean of treatment strategy. Assess mean of treatment failure by immediate follow-up PAP smear and recurrence rate by long-term follow-up smears.

Results: Both groups of patients received similar treatments for their cervical anomalies. HIV-positive women were two times more likely to have involved margins after conisation than HIV-negative women (P < 0.01). Globally, two thirds of HIV-negative patients had a first follow-up PAP smear that was normal, while this was the case in only one third of HIV-positive women. These proportions were also significantly different after conisation (P < 0.01). The same differences were also observed after sustained follow-up. HIV-infected women who showed a recurrence of dysplasia were more likely to have failed antiviral therapy (9/44) than those without any recurrence (7/12) (P < 0.01).

Conclusions: Higher rates of recurrence were observed among HIV-infected women, indicating that CIN management is more difficult and may require adapted guidelines in HIV-positive patients. In HIV-infected patients, an association was found between the absence of recurrence and a viral response to antiviral therapy.

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • Case-Control Studies
  • Cervical Intraepithelial Neoplasia / surgery
  • Cervical Intraepithelial Neoplasia / therapy*
  • Cervical Intraepithelial Neoplasia / virology*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • HIV*
  • Humans
  • Neoplasm Recurrence, Local / virology
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Cervical Neoplasms / surgery
  • Uterine Cervical Neoplasms / therapy*
  • Uterine Cervical Neoplasms / virology*
  • Viral Load