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Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia
Karolinska Inst, Sweden; Uppsala Univ, Sweden.
Uppsala Univ, Sweden.
Linköping University, Faculty of Medicine and Health Sciences.
Univ Gothenburg, Sweden.
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2018 (English)In: AIDS (London), ISSN 0269-9370, E-ISSN 1473-5571, Vol. 32, no 11, p. 1475-1484Article in journal (Refereed) Published
Abstract [en]

Objectives: To assess if women living with HIV (WLWH) have poorer outcome after treatment of cervical intraepithelial neoplasia grade 2, grade 3, adenocarcinoma in situ or cervical cancer (CIN2+) than HIV-negative women (HNW) and to identify predictors of CIN2+ treatment failure and recurrence in WLWH. Design: Population-based cohort study with follow-up between 1983 and 2015. Methods: The Swedish National HIV Registry, the Swedish Population Registry and the Swedish National Cervical Screening Registry were linked to identify all women in Stockholm and Gothenburg counties (Sweden) living with HIV and diagnosed with CIN2+ (n = 179) sometime between 1983 and 2014. For each WLWH, two HNW resident in the same counties and matched for country of birth, diagnosed with CIN2+, were chosen as controls. Treatment failure was defined as the presence of CIN2+ at initial follow-up. Recurrence was defined as the presence of CIN1+ subsequent to an initial normal follow-up. Results: WLWH were three times more likely to have treatment failure (odds ratio (OR) 3.7 [95% confidence interval (CI) 2.0-6.8]) and five times more likely to recur (hazard ratio 5.0 [95% CI 2.1-11.6]) than HNW. Suppressive antiretroviral therapy (ART) at time of treatment of CIN2+ was associated with reduced OR of treatment failure (OR 0.3 [95% CI 0.1-0.8]). Immunosuppression (CD4(+) cell count amp;lt; 200 cells/mu l) associated strongly with treatment failure (OR compared with CD4 (+) cell count amp;gt;= 500: 8.5 [95% CI 2.3-30.7]). Conclusion: Suppressive ART is associated with effective treatment of CIN2+. Early HIV diagnosis and ART are essential for successful CIN2+ treatment. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2018. Vol. 32, no 11, p. 1475-1484
Keywords [en]
cervical intraepithelial lesions; excision treatment outcome; HIV; human papillomavirus; recurrence; treatment failure
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:liu:diva-150496DOI: 10.1097/QAD.0000000000001853ISI: 000441209000010PubMedID: 29746299OAI: oai:DiVA.org:liu-150496DiVA, id: diva2:1241684
Note

Funding Agencies|Swedish Physicians Against AIDS Committee; Swedish Research Council; Swedish Association of Local Authorities and Regions; Vastmanland County Council, Sweden

Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24

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