Cervical Intraepithelial Neoplasia In HIV-infected Women Research Articles

Treatment Failure and Recurrence of Cervical Intraepithelial Neoplasia in HIV-Infected Women

Evaluation of: Reimers LL, Sotardi S, Daniel D et al.: Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women. Gynecol. Oncol. 119, 92-97 (2010). In a retrospective cohort study of 136 HIV-infected women who had a loop electrosurgical excision procedure (LEEP) or cone procedure for cervical intraepithelial neoplasia (CIN), Reimers et al. show that treatment failure and recurrence of CIN was common. Most recurrent CIN lesions, and those detected at treatment failure, were high-grade lesions. Both treatment failure and subsequent recurrence of CIN were found to be high in women with poorly controlled HIV, after LEEP, and those with positive cervical tissue margins following treatment. Based on these data the authors suggest that cervical conization may be superior to LEEP in the treatment of CIN in HIV-infected women.

Prevalence and risk factors for cervical intraepithelial neoplasia in HIV-infected women in Salvador, Bahia, Brazil.

The human immunodeficiency virus (HIV) is frequently associated with high-grade intraepithelial neoplasia. Immunosuppression and high HIV viral load are the main risk factors for cervical intraepithelial neoplasia (CIN). The aim of this study was to determine the prevalence of CIN in HIV-infected women in Salvador, Bahia, Brazil, and to describe the risk factors in comparison with non-infected women. Cross-sectional study at the AIDS Reference Center of Bahia and the Gynecological Outpatient Clinic of Fundação Bahiana para o Desenvolvimento da Ciência, in Salvador, Bahia, Brazil. Sixty-four HIV-infected women and 76 uninfected women from Salvador were enrolled between May 2006 and May 2007. Associations between CIN and presence of HIV infection, HIV viral load, proportion of T CD4+ lymphocytes and risk factors were evaluated. The independence of the risk factors was investigated using logistic regression. CIN was more prevalent among HIV-infected women than in the control group (26.6% versus 6.6%; P = 0.01). The odds ratio for CIN among HIV-infected women was 3.7 (95% confidence interval, CI: 1.23-11; P = 0.01), after adjusting for the following variables: age at first sexual intercourse, number of partners, number of deliveries and previous history of sexually transmitted disease. The prevalence of CIN among HIV-infected women was significantly higher than among women without HIV infection. HIV infection was the most important risk factor associated with the development of cervical lesions.

Prevalence, Risk Factors, and Accuracy of Cytologic Screening for Cervical Intraepithelial Neoplasia in Women with the Human Immunodeficiency Virus

Abstract Objectives. The objective was to evaluate the sensitivity and specificity of cervical cytology in women infected with the human immunodeficiency virus (HIV), risk factors for abnormal cytology in HIV-infected and uninfected women, and risk factors for histologic diagnosis of cervical intraepithelial neoplasia (CIN) in HIV-infected women. Methods. Methods included a cross-sectional analysis of cervical cytology, colposcopic impression, and histology in 248 HIV-infected women and multivariate analyses of risk factors for abnormal cytology in 253 HIV-infected and 220 uninfected women and risk factors for CIN in 186 HIV-infected women. Results. The sensitivity and specificity of cytology for all CIN grades were 0.60 and 0.80 and, for high-grade CIN, 0.83 and 0.74. The prevalence of abnormal cytology was 32.9% in HIV-infected and 7.6% in HIV-negative women. Independent risk factors for abnormal cytology were immunodeficiency [odds ratio (OR) 8–17, P P P = 0.005). Conclusion. Given the high prevalence of abnormal cytology and CIN in HIV-infected women, cytologic screening has significant limitations. Both immunodeficiency and type of HPV infection are important risk factors.

Prevalence, Risk Factors, and Accuracy of Cytologic Screening for Cervical Intraepithelial Neoplasia in Women with the Human Immunodeficiency Virus

Objectives.The objective was to evaluate the sensitivity and specificity of cervical cytology in women infected with the human immunodeficiency virus (HIV), risk factors for abnormal cytology in HIV-infected and uninfected women, and risk factors for histologic diagnosis of cervical intraepithelial neoplasia (CIN) in HIV-infected women.Methods.Methods included a cross-sectional analysis of cervical cytology, colposcopic impression, and histology in 248 HIV-infected women and multivariate analyses of risk factors for abnormal cytology in 253 HIV-infected and 220 uninfected women and risk factors for CIN in 186 HIV-infected women.Results.The sensitivity and specificity of cytology for all CIN grades were 0.60 and 0.80 and, for high-grade CIN, 0.83 and 0.74. The prevalence of abnormal cytology was 32.9% in HIV-infected and 7.6% in HIV-negative women. Independent risk factors for abnormal cytology were immunodeficiency [odds ratio (OR) 8–17,P< 0.001] and human papillomavirus (HPV) infection (OR = 5,P< 0.001). The prevalence of CIN on histology was 32% in HIV-infected women, and the only independent risk factor for CIN was oncogenic HPV type (OR = 5,P= 0.005).Conclusion.Given the high prevalence of abnormal cytology and CIN in HIV-infected women, cytologic screening has significant limitations. Both immunodeficiency and type of HPV infection are important risk factors.

THE SENSITIVITY OF CERVICAL CYTOLOGY IN HIV-INFECTED WOMEN

BACKGROUND: Studies demonstrating a high prevalence of abnormal Pap smears and cervical intraepithelial neoplasia (CIN) in HIV-infected women have led to concerns about appropriate surveillance measures. The objective of this evaluation was to determine the specificity and sensitivity of cervical cytology in a large group of HIV-infected women. METHODS: From 1991 to 1994, 285 HIV-infected women were enrolled in a prospective cohort study of the natural history of HIV disease and associated gynecologic manifestations. The baseline examination included cervical cytology, colposcopy and colposcopically directed biopsy. If no lesion was visualized colposcopically, a biopsy was taken of the transformation zone. All cytology slides were reviewed by a senior cytologist after initial evaluation. All histopathology slides were reviewed by an experienced pathologist blinded to the woman's HIV status. RESULTS: Among 249 HIV-infected women who had cervical cytology, colposcopy and cervical biopsy, 32.4% had abnormal cytology, including 8.8% with atypical squamous cells of undetermined significance (ASCUS), 15.6% with low grade squamous intraepithelial lesions (SIL) and 8.0% with high grade SIL. On colposcopic visualization, 75% had lesions consistent with CIN or condylomatous lesions. Histology showed CIN1 in 19.3%, CIN2 in 7.6%, and CIN3 in 4.0%. The sensitivity and specificity of cytology for CIN of all grades were 0.60 and 0.80 respectively. For high grade CIN, the sensitivity and specificity were 0.83 and 0.74. The false negative rate of normal smears was 18% with 5 cases of CIN 2-3 and 26 of CIN 1. All women with CIN 2-3 had either an abnormal smear or a lesion on colposcopy. However, 15% of women with normal smears and no colposcopic evidence of CIN had CIN 1 on biopsy. CONCLUSION: Cervical cytology in HIV-infected women has sensitivity and specificity within the range reported in normal populations. However, the high prevalence of CIN in the immunodeficient suggest that colposcopy or other tests should supplement cytology because of its inherent limited sensitivity. Studies of the potential for progression of CIN in HIV-infected women are needed to resolve questions on appropriate screening protocols.

Multiple recurrences of cervical intraepithelial neoplasia in women with the human immunodeficiency virus

To evaluate the long-term outcomes after treatment of cervical intraepithelial neoplasia (CIN) in women infected with the human immunodeficiency virus (HIV). Human immunodeficiency virus-infected and HIV-negative women treated for CIN by ablation or excision were followed-up prospectively by cytology and colposcopy for periods of up to 73 months. Among 127 HIV-infected CIN patients, 62% developed recurrent CIN by 36 months after treatment, compared with 18% of the 193 HIV-negative CIN patients. Recurrence rates reached 87% in 41 HIV-infected women with CD4 counts less than 200 cells/mm3. Progression to higher-grade neoplasia, including one invasive cancer, occurred by 36 months in 25% of HIV-infected and 2% of HIV-negative women. After adjusting for age, CIN severity, and treatment type, predictors of recurrence included HIV infection (rate ratio 4.4), and, in HIV-positive women, low CD4 count (rate ratio 2.2). In patients treated by excision, predictors of recurrence included HIV infection (rate ratio 2.0) and residual CIN after treatment (rate ratio 2.7). After a second treatment,a second CIN recurrence developed in 14 of 33 HIV-infected and in one of 17 HIV-negative women. After a third treatment, three of six HIV-infected women developed a third recurrence. With long-term follow-up, 45% of treated HIV-infected CIN patients had chronic condylomatous changes in the cervix compared with 5% of HIV-negative women. In HIV-infected women, CIN may recur despite multiple treatments, and chronic condylomatous changes are common. Innovative therapies for controlling CIN in HIV-infected women are needed.