767 Long-term Effect of Highly Active Antiretroviral Therapy on Histological Cervical Squamous Intra-epithelial Lesions among HIV+ Women C. Uberti-Foppa*1, D. Ferrari2, S. Lodini3, S. Reina4, F. Ameglio4, M. A. Grasso3, G. Gallotta5, G. Taccagni6, A. Lazzarin7, F. Lillo8 1Infectious Diseases, HRS Hosp, Milano, Italy; 2Obstetrics and Gynecology, HSR Hosp, Milano, Italy; 3Virology, HSR Hosp, Milano, Italy; 4Statistics for Res SFR Ltd, Basle, Switzerland; 5Infectious Diseases, HSR Hosp, Milano, Italy; 6Pathology, HSR Hosp, Milano, Italy; 7Infectious Diseases, HSR Hosp, Milano, Italy; and 8Virology, HSR Hosp, Milano, Italy
Background: Due to the contrasting results reported in literature, we assessed the effect of long-term highly active antiretroviral therapy (HAART) on persistent high-risk oncogenic human papillomavirus infection (HR-HPV) and histological cervical lesions in HIV+ women receiving 2 reverse transcriptase inhibitors (RTIs), HAART or no treatment.
Methods: We analyzed 154 women longitudinally followed up every 6-12 months (mos) in our gynecological unit (mean follow-up: 36.4 + 10.4 mos) by means of Pap smears, colposcopy (with biopsy when indicated), and cervicovaginal swabs for the detection of HPV genomic sequences. CD4 and log-adjusted HIV-RNA values were analyzed to ensure the baseline homogeneity of the patients (pts) who were subsequently divided into those considered stable (group S) who did not change anti-HIV therapy and those with clinical or virological worsening (group W) who switched to a more potent HAART. The characteristics of HPV-DNA were evaluated using the Chi-square test, contingency tables and Fisher's exact test as necessary.
Results: CD4 levels significantly increased in the group S HAART pts (p = 0.017) and in those switching to more potent HAART (p = 0.0001), but this was not associated with a decreased persistence of HR-HPV. HIV viremia significantly decreased in the pts switching to more potent therapy (p = 0.0016) and remained substantially unchanged in group S. In a variance analyses over time, NT, HAART, and RTIs women were tested for a possible influence in PAP and histological outcome: no one was associated to a variation for cytology, while a significant reduction of positive biopsies was found only in stably long-term on-HAART women (p = 0.00006).
Conclusions: Our data show that, after a careful selection of comparable groups of treatment, HAART works effectively on HPV-related histological lesions only in pts on long-term effective therapy (global and selected cases).
