Lower Incidence of Cervical Intraepithelial Neoplasia in HIV+ Women under HAART
Isabelle Heard*1, V Potard2, D Costagliola2, and M Kazatchkine1
1INSERM U430, Hosp G Pompidou, Paris, France and 2INSERM EMI 0214, Paris, France
Background: Although HAART has lowered the incidence of
various opportunistic diseases, its effect on incidence of cervical
intraepithelial neoplasia (CIN) is unclear. Our objective was to compare the
incidence of CIN in HIV-infected women under HAART versus non-treated women and
to determine the role of risk factors in the pathogenesis of CIN.
Methods: A prospective study of cervical disease in
HIV-positive women with a semestrial follow-up—including colposcopy, Pap smears,
and biopsy—was initiated in 1993. A total of 316 women with no evidence of CIN at study entry were followed-up until incident CIN confirmed by biopsy or last follow-up visit.
Cox analyses were used to assess the risk of incident CIN
associated with HAART. HAART was entered as a time-dependent covariate
according to the date of first prescription.
Results: During a median follow-up of 26.5 months (14.0
to 54.8), 101 women developed CIN
(incidence of 10 cases per 100 person-years). Of CIN,
86 were low-grade. No invasive cervical cancers were identified. By
multivariate analysis, significant risk factors for incident lesion were age
below 40 (relative risk 2.8; 95% CI 1.1 to 7.0, p = 0.03 ) and tobacco use (RR, 1.6; 95% CI 1.0 to 2.5, p = 0.05). Incidence decreased from 12
to 8/100 person-years in non treated versus treated women and women under HAART
had a twice reduced risk to develop CIN
during follow-up (RR 0.5; 95% CI 0.3 to 0.9, p = 0.01).
Conclusions: HAART modified the course of CIN by significantly reducing the incidence of
lesions. Nevertheless, although HAART likely delays occurrence of lesions, all
HIV+ women should participate in cervical cancer screening programs.
Keywords: cervical dysplasia; women; surgery