Highly active antiretroviral therapy and incidence of cervical squamous intraepithelial lesions among HIV-infected women with normal cytology and CD4 counts above 350 cells/mm3

Sirera, Guillem; Videla, Sebastià; López-Blázquez, Raquel; Llatjós, Mariona; Tarrats, Antoni; Castellà, Eva; Grané, Nuria; Tural, Cristina; Rey-Joly, Celestino; Clotet, Bonaventura

doi:10.1093/jac/dkm412

Cited by 29 publications

(35 citation statements)

References 9 publications

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“…Within study comparisons, however, show that in 6 studies, lower CD4 count was associated with an increased incidence of abnormal cervical cytology 7,10,19,21,26,27 , although most estimates were not statistically significant. Two studies assessed nadir CD4 counts and reported no statistically significant relationship with incidence 29,31 .…”

Section: Resultsmentioning

confidence: 99%

“…Though one study showed a reduction in incidence with HAART use versus non-HAART use 22 , most studies found no significant difference between HAART/ART use and non-use 19,26,31,32 . Associations may be confounded by the practice of initiating ART use only in patients with low CD4 counts or lack comparability due to differences in CD4 count recovery, HIV viremia, and follow-up time after ART initiation.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and progression of cervical lesions in women with HIV: a systematic global review

et al. 2013

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Summary Objective Global data on cervical lesion incidence and progression in HIV-positive is essential for understanding the natural history of cervical neoplasia and informing screening policy. Methods A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Results Of 5,882 HIV-positive women from 15 studies, incidence ranged from 4.9 to 21.1 cases per 100 woman-years for any cervical lesion and 0.4 to 8.8 cases per 100 woman-years for high grade cervical lesions. HIV-positive women showed a median 3-fold higher incidence of cervical lesions compared to HIV-negative women. Of 1,099 HIV-positive women from 11 studies, progression from low to high grade lesions ranged from 1.2 to 26.2 cases per 100 woman-years. Both incidence and progression rates increased with lower CD4 counts. The effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear. Conclusions HIV-positive women have higher incidence and progression of cervical neoplasia. Cervical cancer screening should be integrated into HIV treatment programs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and progression of cervical lesions in women with HIV: a systematic global review

et al. 2013

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“…Researchers also differed in their treatment of atypical squamous cells of undetermined significance (ASCUS). Some considered a change of cytology result from low grade SIL (LSIL) to ASCUS as regression, [13] others resolved diagnoses of ASCUS with colposcopy and histology,[27] and still others left ASCUS diagnoses out of analysis[28]. …”

Section: Resultsmentioning

confidence: 99%

“…In a well-characterized French cohort with a median follow-up period of 28 months, there was no independent effect of receiving antiretroviral therapy or restored immune status (evidenced by higher CD4+ T-cell counts) on incident SIL, which were significantly associated only with being in the 30-39 years age group[22]. In a retrospective analysis of a cohort from Spain of HIV-infected women with CD4+ cell counts >350 cells/mm 3 and with no previous SIL, there was no significant difference in SIL incidence between groups receiving versus not receiving HAART[28]. …”

Section: Resultsmentioning

confidence: 99%

RTehvieew impact of antiretroviral therapy on HPV andcervical intraepithelial neoplasia: current evidence and directions for future research

Bratcher

Sahasrabuddhe

2010

Infect Agents Cancer

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Increasing numbers of human immunodeficiency virus (HIV)-infected women are now accessing life-prolonging highly active antiretroviral therapy (HAART) in developing countries. There is a need for better understanding of interactions of human papillomavirus (HPV) and HIV, especially in the context of increasing life expectancy due to HAART. The data regarding the impact of HAART on reducing the incidence and progression and facilitating the regression of HPV infection and cervical abnormalities is largely inconsistent. Published studies differ in their study designs (prospective or retrospective cohorts or record linkage studies), screening and diagnostic protocols, duration and type of HAART use, recruitment and referral strategies, and definitions of screening test and disease positivity. Due to the ethical and resource limitations in conducting randomized trials of the impact of HAART on incidence of HPV, CIN, and cervical cancer among HIV-infected women, it is important to consider innovative study designs, including quasi-experimental trials and operations research in sentinel populations to answer the critical research questions in this area.

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“…Compared to those who are not on HAART, HIV-infected women on antiretroviral therapy tend to have a lower incidence rate of SILs [2] and higher probability of remaining free of SILs [21]. However, the effect of HAART on changes of SILs remains unclear and controversial.…”

Section: Discussionmentioning

confidence: 99%

Effect of Highly Active Antiretroviral Therapy (HAART) and Menopause on Risk of Progression of Cervical Dysplasia in Human Immune-Deficiency Virus- (HIV-) Infected Women

Kim

Messing

Shah

et al. 2013

Infectious Diseases in Obstetrics and Gynecology

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Background. More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions (SILs) on these women. Methods. To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis. Results. Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen or no regimen (CI: 0.33–0.70, P = 0.0001). A greater increase of CD4+ cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11–2.62, P < 0.0001), adjusting for HIV medications, CD4+ count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking. Conclusion. HAART had a positive long-term effect on the progression to SILs. However, being younger and menopausal increases the risk of progression.

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Highly active antiretroviral therapy and incidence of cervical squamous intraepithelial lesions among HIV-infected women with normal cytology and CD4 counts above 350 cells/mm3

Cited by 29 publications

References 9 publications

Incidence and progression of cervical lesions in women with HIV: a systematic global review

Incidence and progression of cervical lesions in women with HIV: a systematic global review

RTehvieew impact of antiretroviral therapy on HPV andcervical intraepithelial neoplasia: current evidence and directions for future research

Effect of Highly Active Antiretroviral Therapy (HAART) and Menopause on Risk of Progression of Cervical Dysplasia in Human Immune-Deficiency Virus- (HIV-) Infected Women

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