Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women

Laura L. Reimers, Susan Sotardi, David Daniel, Lydia G. Chiu, Anne R. Van Arsdale, Daryl L. Wieland, Jason M. Leider, Xiaonan (Nan) Xue, Howard Strickler, David J. Garry, Gary L. Goldberg, Mark H. Einstein

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (> 70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR = 1.76; 95% CI: 1.15-2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95% CI: 1.90-19.73). Conclusions: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.

Original languageEnglish (US)
Pages (from-to)92-97
Number of pages6
JournalGynecologic Oncology
Volume119
Issue number1
DOIs
StatePublished - Oct 2010

Fingerprint

Cervical Intraepithelial Neoplasia
Treatment Failure
HIV
Recurrence
Conization
CD4 Lymphocyte Count
Cohort Studies
Therapeutics
Retrospective Studies
Databases
RNA
Population
Neoplasms

Keywords

  • Cervical conization
  • Cervical intraepithelial neoplasia
  • HIV
  • LEEP
  • Loop electrosurgical excision procedure

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Medicine(all)

Cite this

Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women. / Reimers, Laura L.; Sotardi, Susan; Daniel, David; Chiu, Lydia G.; Van Arsdale, Anne R.; Wieland, Daryl L.; Leider, Jason M.; Xue, Xiaonan (Nan); Strickler, Howard; Garry, David J.; Goldberg, Gary L.; Einstein, Mark H.

In: Gynecologic Oncology, Vol. 119, No. 1, 10.2010, p. 92-97.

Research output: Contribution to journalArticle

Reimers, LL, Sotardi, S, Daniel, D, Chiu, LG, Van Arsdale, AR, Wieland, DL, Leider, JM, Xue, XN, Strickler, H, Garry, DJ, Goldberg, GL & Einstein, MH 2010, 'Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women', Gynecologic Oncology, vol. 119, no. 1, pp. 92-97. https://doi.org/10.1016/j.ygyno.2010.06.012
Reimers, Laura L. ; Sotardi, Susan ; Daniel, David ; Chiu, Lydia G. ; Van Arsdale, Anne R. ; Wieland, Daryl L. ; Leider, Jason M. ; Xue, Xiaonan (Nan) ; Strickler, Howard ; Garry, David J. ; Goldberg, Gary L. ; Einstein, Mark H. / Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women. In: Gynecologic Oncology. 2010 ; Vol. 119, No. 1. pp. 92-97.
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abstract = "Objective: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results: Treatment failure at initial follow-up was common, occurring in 51{\%} of CIN 1 and 55{\%} of CIN 2+. Most lesions detected at treatment failure were high grade (> 70{\%}), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR = 1.76; 95{\%} CI: 1.15-2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55{\%} eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95{\%} CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95{\%} CI: 1.90-19.73). Conclusions: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.",
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AU - Sotardi, Susan

AU - Daniel, David

AU - Chiu, Lydia G.

AU - Van Arsdale, Anne R.

AU - Wieland, Daryl L.

AU - Leider, Jason M.

AU - Xue, Xiaonan (Nan)

AU - Strickler, Howard

AU - Garry, David J.

AU - Goldberg, Gary L.

AU - Einstein, Mark H.

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N2 - Objective: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (> 70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR = 1.76; 95% CI: 1.15-2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95% CI: 1.90-19.73). Conclusions: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.

AB - Objective: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. Methods: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. Results: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (> 70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR = 1.76; 95% CI: 1.15-2.64), and low CD4+ count (p = 0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR] = 3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR = 6.12; 95% CI: 1.90-19.73). Conclusions: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.

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KW - HIV

KW - LEEP

KW - Loop electrosurgical excision procedure

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