JAC Advance Access published online on October 31, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm412
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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
1 HIV Clinical Unit, Department of Medicine, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (U.A.B.), Badalona (Barcelona), Spain 2 Lluita Contra La SIDA Foundation, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (U.A.B.), Badalona (Barcelona), Spain 3 Department of Statistics, Universitat Politècnica de Barcelona, Barcelona, Spain 4 Department of Pathology, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (U.A.B.), Badalona (Barcelona), Spain 5 Department of Gynecology, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (U.A.B.), Badalona (Barcelona), Spain
Received 18 June 2007; returned 27 August 2007; revised 18 September 2007; accepted 7 October 2007
* Corresponding author. Tel: +34-609-059-287; Fax: +34-93-465-76-02; E-mail: svidela{at}esteve.es
Objectives: To provide evidence for the long-term effect of highly active antiretroviral therapy (HAART) on the incidence of cervical squamous intraepithelial lesions (SILs) among HIV-positive women with normal cytology test and CD4 count above 350 cells/mm3.
Patients and methods: A retrospective cohort study was carried out in HIV-positive women with two consecutive normal cervical cytological tests (Papanicolaou test) and at least one subsequent test, without previous cervical history of SIL or cancer diagnosis, and with an immunological status >350 CD4 cells/mm3. The patients were divided into two groups: treated with HAART (HAART group) or not treated with HAART (NO-HAART group), during the period of time between cytology tests included in the survival analysis and time until SIL.
Results: Between January 1997 and December 2006, 127 women were included: 90 in the HAART group and 37 in the NO-HAART group. Both groups of patients were similar with respect to demographic data, except for HIV viral load and previous HAART inclusion (P < 0.001). SIL was diagnosed in 27 of 90 (30%) patients in the HAART group and in 7 of 37 (19%) patients in the NO-HAART group (OR = 1.84, 95% CI: 0.72–4.69, P = 0.202). The actuarial probability of remaining free of SIL at 3 years was 70% in the HAART group and 78% in the NO-HAART group. No variable was associated with an increased risk of developing SILs.
Conclusions: These results suggest that when the patients' immunological status is above 350 CD4 cells/mm3, the HIV-infected women treated with HAART present a similar cervical SIL incidence to women not on HAART.
Key Words: HAART , immunological status , cervical SIL in HIV , women
These authors contributed equally to this study.