Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age

Christine Colie, Katherine G. Michel, Leslie S. Massad, Cuiwei Wang, Gypsyamber DʼSouza, Lisa Rahangdale, Lisa Flowers, Joel Milam, Joel M. Palefsky, Howard Minkoff, Howard Strickler, Seble G. Kassaye

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. METHODS: Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. RESULTS: Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4 T-cell count. In HIV-positive women, each increase of 100 CD4 T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. CONCLUSIONS: CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.

Original languageEnglish (US)
Pages (from-to)573-579
Number of pages7
JournalJournal of acquired immune deficiency syndromes (1999)
Volume79
Issue number5
DOIs
StatePublished - Dec 15 2018

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HIV-2
Cervical Intraepithelial Neoplasia
HIV
Uterine Cervical Neoplasms
Therapeutics
Confidence Intervals
T-Lymphocytes
CD4 Lymphocyte Count
Natural History

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age. / Colie, Christine; Michel, Katherine G.; Massad, Leslie S.; Wang, Cuiwei; DʼSouza, Gypsyamber; Rahangdale, Lisa; Flowers, Lisa; Milam, Joel; Palefsky, Joel M.; Minkoff, Howard; Strickler, Howard; Kassaye, Seble G.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 79, No. 5, 15.12.2018, p. 573-579.

Research output: Contribution to journalArticle

Colie, C, Michel, KG, Massad, LS, Wang, C, DʼSouza, G, Rahangdale, L, Flowers, L, Milam, J, Palefsky, JM, Minkoff, H, Strickler, H & Kassaye, SG 2018, 'Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age', Journal of acquired immune deficiency syndromes (1999), vol. 79, no. 5, pp. 573-579. https://doi.org/10.1097/QAI.0000000000001865
Colie, Christine ; Michel, Katherine G. ; Massad, Leslie S. ; Wang, Cuiwei ; DʼSouza, Gypsyamber ; Rahangdale, Lisa ; Flowers, Lisa ; Milam, Joel ; Palefsky, Joel M. ; Minkoff, Howard ; Strickler, Howard ; Kassaye, Seble G. / Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age. In: Journal of acquired immune deficiency syndromes (1999). 2018 ; Vol. 79, No. 5. pp. 573-579.
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abstract = "OBJECTIVE: To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. METHODS: Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. RESULTS: Most women were African American (53{\%}), current smokers (53{\%}), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6{\%}) did not receive CIN2 treatment. Twelve HIV-positive women (11.5{\%}) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95{\%} confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4 T-cell count. In HIV-positive women, each increase of 100 CD4 T cells was associated with a 33{\%} decrease in CIN2 progression (adjusted hazard ratio 0.67; 95{\%} confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. CONCLUSIONS: CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.",
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AU - DʼSouza, Gypsyamber

AU - Rahangdale, Lisa

AU - Flowers, Lisa

AU - Milam, Joel

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N2 - OBJECTIVE: To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. METHODS: Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. RESULTS: Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4 T-cell count. In HIV-positive women, each increase of 100 CD4 T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. CONCLUSIONS: CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.

AB - OBJECTIVE: To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. METHODS: Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. RESULTS: Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4 T-cell count. In HIV-positive women, each increase of 100 CD4 T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. CONCLUSIONS: CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.

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