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Progression and Persistence of Low-Grade Cervical Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus

Zeier, Michèle Desiré MD1; Botha, Matthys Hendrik MMed, PhD2; van der Merwe, Frederick Haynes MMed2; Eshun-Wilson, Ingrid MD1; van Schalkwyk, Marije MD1; la Grange, Marina BOccTher1; Mason, Deidre MD2; Louw, Mercia MMed3; Nachega, Jean B. MD, PhD1,4,5

Journal of Lower Genital Tract Disease: July 2012 - Volume 16 - Issue 3 - p 243–250
doi: 10.1097/LGT.0b013e3182403d18
Original Articles

Objective This study aimed to investigate the progression and persistence of low-grade squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)–infected women.

Methods Study participants for this retrospective cohort study were 1,720 women who had LSIL as their first abnormal Pap smear. A comparison of the survival of LSIL without progression to high-grade SIL as progression-free time and the survival of SIL without clearance of the lesion as persistence of SIL was done for women of HIV-positive, HIV-negative, or unknown status using the Kaplan-Meier method. Multivariable Cox proportional hazards regression model was applied to identify independent risk factors for disease progression or persistence.

Results We found progression of LSIL not different between HIV groups but that persistence occurred more in HIV-positive women (63.8% vs 35.0%, p < .001). For the HIV group, antiretroviral therapy that was started before the first LSIL was associated with decreased risk for progression compared with no antiretroviral therapy (hazard ratio = 0.66, 95% CI = 0.54–0.81, p < .001). Antiretroviral therapy also improved clearance when corrected for excision treatment and age (hazard ratio = 1.71, 95% CI = 1.29–2.27, p < .001). Excision of LSIL reduced the risk of progression. In HIV-negative women, progression was reduced from 54.7% to 0.0% (p < .001), and from 46.9% to 6.4% in HIV-positive women (p < .001). Excision also reduced persistence in HIV-negative women from 39.5% to 7.1% (p = .001), but for HIV-positive women, the effect was smaller (from 66.3% to 45.5%, p < .001).

Conclusions Antiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.

Antiretroviral treatment reduced the risk for progression and persistence of low-grade squamous intraepithelial lesion in human immunodeficiency virus–positive women.

Departments of 1Medicine and Centre for Infectious Diseases and 2Obstetrics and Gynecology and 3Pathology, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; and Departments of 4International Health and 5Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Reprint requests to: Michèle Desiré Zeier, MD, Department of Medicine and Centre for Infectious Diseases, Room 3144, Clinical Building, Stellenbosch University, Francie van Zyl Drive, Parow, 7505, South Africa. E-mail:

Michèle Zeier, Marina La Grange, and Marije van Schalkwyk are supported by the Anova Health Institute’s ShareCare program through the US President’s Emergency Plan for AIDS Relief (PEPFAR) program and the US Agency for International Development under Cooperative Agreement no. 674-A-00-08-00009-00. Jean Nachega is supported by the US National Institutes for Allergy and Infectious Disease, Division of AIDS (K23 AI 068582-01), by the US PEPFAR grant award (T84HA21652-01-00) for Medical Education Partnership Initiative, by the European Developing Countries Clinical Trial Partnership Senior Fellowship Award (TA-08-40200-021), and by the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA).

©2012The American Society for Colposcopy and Cervical Pathology