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Outcomes After Treatment of Cervical Intraepithelial Neoplasia Among Women With HIV

Massad, L. Stewart MD1; Fazzari, Melissa J. MS2; Anastos, Kathryn MD3; Klein, Robert S. MD2; Minkoff, Howard MD4; Jamieson, Denise J. MD, MPH5; Duerr, Ann MD, PhD5; Celentano, David ScD, MHS6; Gange, Stephen PhD6; Cu-Uvin, Susan MD7; Young, Mary MD8; Watts, D. Heather MD9; Levine, Alexandra M. MD10; Schuman, Paula MD, MPH11; Harris, Tiffany G. PhD2; Strickler, Howard D. MD, MPH2

Journal of Lower Genital Tract Disease: April 2007 - Volume 11 - Issue 2 - pp 90-97
doi: 10.1097/01.lgt.0000245038.06977.a7
Original Articles
Spanish Translation

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.

Initial failures and later recurrences after treatment of cervical intraepithelial neoplasia are common in women with HIV, but most are low grade.

1Southern Illinois University School of Medicine, Springfield, IL, 2Albert Einstein College of Medicine, Bronx, NY, 3Montefiore Medical Center, Bronx, NY, 4Maimonides Medical Center, Brooklyn, NY, 5Centers for Disease Control and Prevention, Atlanta, GA, 6Johns Hopkins University, Baltimore, MD, 7Brown University School of Medicine, Providence, RI, 8Georgetown University Medical Center, Washington, DC, 9National Institute of Child Health and Human Development, Bethesda, MD, 10University of Southern California, Los Angeles, CA, 11Wayne State University, Detroit, MI

The HER Study Group consists of Robert S. Klein, MD, Ellie Schoenbaum, MD, Julia Arnsten, MD, MPH, Robert D. Burk, MD, Chee Jen Chang, PhD, Penelope Demas, PhD, and Andrea Howard, MD, MSc, from Montefiore Medical Center and the Albert Einstein College of Medicine; Paula Schuman, MD, and Jack Sobel, MD, from the Wayne State University School of Medicine; Anne Rompalo, MD, David Vlahov, PhD, and David Celentano, PhD, from the Johns Hopkins University School of Medicine; Charles Carpenter, MD, and Kenneth Mayer, MD, from the Brown University School of Medicine; Ann Duerr, MD, Lytt I. Gardner, PhD, Charles M. Heilig, PhD, Scott Holmberg, MD, Denise Jamieson, MD, Jan Moore, PhD, Ruby Phelps, BS, Dawn Smith, MD, and Dora Warren, PhD, from the Centers for Disease Control and Prevention; and Katherine Davenny, PhD, from the National Institute of Drug Abuse.

Reprint requests to: L. Stewart Massad, MD, Department of Obstetrics and Gynecology, Southern Illinois University, P.O. Box 19640, Springfield, IL 62794-9640. E-mail: lsmassad@ameritech.net

©2007The American Society for Colposcopy and Cervical Pathology