Outcomes After Treatment of Cervical Intraepithelial Neoplasia Among Women With HIV

J Low Genit Tract Dis. 2007 Apr;11(2):90-7. doi: 10.1097/01.lgt.0000245038.06977.a7.

Abstract

Objective: To describe outcomes after treatment of cervical intraepithelial neoplasia (CIN) in women with HIV.

Materials and methods: Women in two prospective cohort studies, the Women's Interagency HIV Study (WIHS) and the HIV Epidemiology Research Study (HERS), were followed every 6 months after treatment of CIN using human papillomavirus (HPV) testing and cytology with colposcopy as indicated. Identification of CIN or a squamous intraepithelial lesion (SIL) within 6 months was defined as treatment failure and later disease as recurrence.

Results: Follow-up was available for 170 HIV-seropositive and 15 HIV-seronegative women. Treatment failed in 84 (45%) women (79 HIV seropositive and 5 HIV seronegative). Failure was more likely in women with lower CD4 counts (CD4 < 200 cells/microL: odds ratio [OR] = 2.96; 95% CI = 1.4-6.2) and detectable HPV DNA (OR 8.20; 95% CI = 1.8-37.4; p = .01). After successful treatment, recurrence-free probabilities at 1,2, 3, and 5 years were .79, .64, .49, and .34, respectively. HIV-seronegative women were less likely to recur than HIV-seropositive women (p = .03). In multivariable analysis of HIV-positive women, recurrence was more likely among women treated for CIN 2,3 (hazard ratio [HR] = 2.4; 95% CI = 1.4-4.8), those with CD4 count of less than 200 cells/microL (HR = 2.9; 95% CI = 1.3-6.5) and those with HPV after treatment (HR 2.9; 95% CI = 1.4-6.1); oncogenic HPV was more strongly associated with recurrence than nononcogenic HPV (p(trend) = .009). Most failures and recurrences were low grade, but one adenocarcinoma was diagnosed 4.2 years after therapy for CIN 1.

Conclusion: Treatment failure and recurrence are common in women with HIV but are usually low grade.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • CD4 Lymphocyte Count
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Carcinoma, Squamous Cell / virology
  • Cervical Intraepithelial Neoplasia / complications
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervical Intraepithelial Neoplasia / therapy*
  • Cervical Intraepithelial Neoplasia / virology
  • Cohort Studies
  • Colposcopy
  • DNA, Viral / isolation & purification
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / immunology
  • HIV Seronegativity
  • HIV Seropositivity / complications
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Odds Ratio
  • Papillomaviridae / genetics
  • Proportional Hazards Models
  • Prospective Studies
  • Recurrence
  • Risk Assessment
  • Time Factors
  • Treatment Failure
  • Treatment Outcome
  • United States
  • Uterine Cervical Neoplasms / complications
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*
  • Uterine Cervical Neoplasms / virology

Substances

  • DNA, Viral