Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-Positive women

Howard Minkoff, Ye Zhong, Robert D. Burk, Joel M. Palefsky, Xiaonan (Nan) Xue, D. Heather Watts, Alexandra M. Levine, Rodney L. Wright, Christine Colie, Gypsyamber D'Souza, L. Stewart Massad, Howard Strickler

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods: Human immunodeficiency virus (HIV)-positive women (Np286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ≥95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results:. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44-0.81]; Pp.001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30-0.82]; Pp.006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07-5.18]; Pp.03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion:. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.

Original languageEnglish (US)
Pages (from-to)681-690
Number of pages10
JournalJournal of Infectious Diseases
Volume201
Issue number5
DOIs
StatePublished - Mar 1 2010

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Papillomavirus Infections
Highly Active Antiretroviral Therapy
HIV
Therapeutics
Confidence Intervals
Squamous Intraepithelial Lesions of the Cervix
Patient Compliance
Virus Replication
Uterine Cervical Neoplasms
Odds Ratio

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

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Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-Positive women. / Minkoff, Howard; Zhong, Ye; Burk, Robert D.; Palefsky, Joel M.; Xue, Xiaonan (Nan); Watts, D. Heather; Levine, Alexandra M.; Wright, Rodney L.; Colie, Christine; D'Souza, Gypsyamber; Massad, L. Stewart; Strickler, Howard.

In: Journal of Infectious Diseases, Vol. 201, No. 5, 01.03.2010, p. 681-690.

Research output: Contribution to journalArticle

Minkoff, Howard ; Zhong, Ye ; Burk, Robert D. ; Palefsky, Joel M. ; Xue, Xiaonan (Nan) ; Watts, D. Heather ; Levine, Alexandra M. ; Wright, Rodney L. ; Colie, Christine ; D'Souza, Gypsyamber ; Massad, L. Stewart ; Strickler, Howard. / Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-Positive women. In: Journal of Infectious Diseases. 2010 ; Vol. 201, No. 5. pp. 681-690.
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abstract = "Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods: Human immunodeficiency virus (HIV)-positive women (Np286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ≥95{\%} of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results:. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95{\%} confidence interval {CI}, 0.44-0.81]; Pp.001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95{\%} CI, 0.30-0.82]; Pp.006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95{\%} CI, 1.07-5.18]; Pp.03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion:. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.",
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T1 - Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-Positive women

AU - Minkoff, Howard

AU - Zhong, Ye

AU - Burk, Robert D.

AU - Palefsky, Joel M.

AU - Xue, Xiaonan (Nan)

AU - Watts, D. Heather

AU - Levine, Alexandra M.

AU - Wright, Rodney L.

AU - Colie, Christine

AU - D'Souza, Gypsyamber

AU - Massad, L. Stewart

AU - Strickler, Howard

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods: Human immunodeficiency virus (HIV)-positive women (Np286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ≥95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results:. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44-0.81]; Pp.001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30-0.82]; Pp.006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07-5.18]; Pp.03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion:. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.

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