Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV

L. Stewart Massad, Melissa J. Fazzari, Kathryn Anastos, Robert S. Klein, Howard Minkoff, Denise J. Jamieson, Ann Duerr, David Celentano, Stephen Gange, Susan Cu-Uvin, Mary Young, D. Heather Watts, Alexandra M. Levine, Paula Schuman, Tiffany G. Harris, Howard D. Strickler

Research output: Contribution to journalArticle

54 Scopus citations

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/μL: 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/μL (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 (ptrend = .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.

Original languageEnglish (US)
Pages (from-to)90-97
Number of pages8
JournalJournal of lower genital tract disease
Volume11
Issue number2
DOIs
StatePublished - Apr 2007

Keywords

  • Cancer prevention
  • Cervical neoplasia
  • HIV inwomen

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Massad, L. S., Fazzari, M. J., Anastos, K., Klein, R. S., Minkoff, H., Jamieson, D. J., Duerr, A., Celentano, D., Gange, S., Cu-Uvin, S., Young, M., Watts, D. H., Levine, A. M., Schuman, P., Harris, T. G., & Strickler, H. D. (2007). Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV. Journal of lower genital tract disease, 11(2), 90-97. https://doi.org/10.1097/01.lgt.0000245038.06977.a7