Journal
AIDS
Volume 26, Issue 13, Pages 1645-1652Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32835536a3
Keywords
cervical cancer; disease progression; disease regression; HAART; Papanicolaou smear
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Funding
- National Institute of Allergy and Infectious Diseases at the National Institutes of Health [1K23AI07759-01A1, P30 AI 078498]
- President's Emergency Plan for AIDS Relief (PEPFAR), through the US Agency for International Development (USAID) [674-A-00-05-00003- 00]
- Fogarty International Center grants for HIV-related malignancies [D43TW000010-21S1]
- NIH [R01HL090312, U2RTW007370/3]
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Objective: To determine the impact of HAART on incidence, regression, and progression of cytopathological abnormalities in HIV-infected women. Design: Prospective cohort. Methods: HIV-infected women (N = 1123) from Soweto, South Africa underwent serial cervical smears that were analyzed and reported using the Bethesda System. The results of HAART and non-HAART users were compared using two statistical approaches: a survival analysis assessing risk of incident smear abnormality among women with baseline normal smear results; and analysis with marginal models assessing for an association between HAART use and likelihood of regression/progression in consecutive smears. Results: After multivariate survival analysis, women using HAART with a normal baseline smear were 38% less likely to have an incident smear abnormality during follow-up than nonusers [confidence interval (Cl) 0.42-0.91; P = 0.01]. Multivariate marginal models analysis identified a significantly increased likelihood (odds ratio 2.61; CI 1.75-3.89; P < 0.0001) of regression of cervical lesions among women on HAART. Conclusion: Our large prospective cohort study adds significant weight to the side of the balance of clinical research supporting the positive impact of HAART on the natural history of human papillomavirus-related cervical disease in HIV-infected women. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
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