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

doi:10.1097/01.lgt.0000245038.06977.a7

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Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV

Journal article

Peer reviewed

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, …

Journal of lower genital tract disease, Vol.11(2), pp.90-97

04/01/2007

DOI: 10.1097/01.lgt.0000245038.06977.a7

PMID: 17415113

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Abstract

OBJECTIVETo describe outcomes after treatment of cervical intraepithelial neoplasia (CIN) in women with HIV.MATERIALS AND METHODSWomen 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.RESULTSFollow-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/microL: 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/microL (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 (p(trend) = .009). Most failures and recurrences were low grade, but one adenocarcinoma was diagnosed 4.2 years after therapy for CIN 1.CONCLUSIONTreatment failure and recurrence are common in women with HIV but are usually low grade.

Details

Title: Subtitle: Outcomes after treatment of cervical intraepithelial neoplasia among women with HIV
Creators: L Stewart Massad
Melissa J Fazzari
Kathryn Anastos - Yeshiva University
Robert S Klein - Yeshiva University
Howard Minkoff - Maimonides Medical Center
Denise J Jamieson
Ann Duerr
David Celentano - Johns Hopkins University
Stephen Gange - Johns Hopkins University
Susan Cu-Uvin - Brown University
Mary Young - Georgetown University
D Heather Watts - National Institutes of Health
Alexandra M Levine - University of Southern California
Paula Schuman - Wayne State University
Tiffany G Harris - Yeshiva University
Howard D Strickler
Resource Type: Journal article
Publication Details: Journal of lower genital tract disease, Vol.11(2), pp.90-97
DOI: 10.1097/01.lgt.0000245038.06977.a7
PMID: 17415113
ISSN: 1089-2591
eISSN: 1526-0976
Language: English
Date published: 04/01/2007
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446516902771

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