The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women

被引:139
作者
Minkoff, H
Ahdieh, L
Massad, LS
Anastos, K
Watts, DH
Melnick, S
Muderspach, L
Burk, R
Palefsky, J
机构
[1] Maimonides Hosp, Dept Obstet & Gynecol, Brooklyn, NY 11219 USA
[2] SUNY Hlth Sci Ctr, Dept Obstet & Gynecol, Brooklyn, NY 11203 USA
[3] Johns Hopkins Univ, Sch Publ Hlth, Div Epidemiol, Baltimore, MD USA
[4] Cook Cty Hosp, Dept Obstet & Gynecol, Chicago, IL 60612 USA
[5] Rush Med Coll, Dept Obstet & Gynecol, Chicago, IL 60612 USA
[6] Montefiore Med Ctr, Dept Med, Bronx, NY 10467 USA
[7] Lincoln Med & Mental Hlth Ctr, Dept Med, Bronx, NY USA
[8] NICHHD, Bethesda, MD 20892 USA
[9] NCI, Bethesda, MD 20892 USA
[10] Univ So Calif, Dept Obstet & Gynecol, Los Angeles, CA 90089 USA
[11] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
关键词
HAART; HIV; human papillomavirus; squamous intraepithelial lesions;
D O I
10.1097/00002030-200111090-00011
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective Cervical intraepithelial neoplasia (CIN), a common condition among HIV-infected women, has been linked to HIV load and immune status. Highly active antiretroviral therapy (HAART) improves immunologic and virologic status. This study was undertaken to determine the relationship between HAART use and CIN. Design Cohort study. The Women's Interagency HIV Study (WINS) in five cities in the USA (Bronx/Manhattan, New York; Brooklyn, New York; Chicago, Illinois; Los Angeles, California; San Francisco Bay area, California; Washington, District of Columbia). Methods HIV-infected women were followed every 6 months with Papanicolaou smears and cervicovaginal lavage for human papillomavirus (HPV) DNA testing. To characterize exposures that changed over time and to capture the dynamic nature of cytologic changes, Papanicolaou smear findings from each participant's consecutive visits were defined as a pair. We determined the proportion of all pairs that exhibited either regression or progression, according to HAART exposure, HPV results and Papanicolaou smear status. As participants could contribute multiple pairs, inferences were based on robust methods to adjust for correlated observations. Results Women with persistent HPV infection were more likely to have progression of their lesions. After adjustment for CD4 cell count and Papanicolaou smear status, women on HAART were 40% (95% confidence interval, 4-81%) more likely to demonstrate regression and less likely (odds ratio, 0.68; 95% confidence interval, 0.52-0.88) to demonstrate progression Conclusions HAART altered the course of HPV disease in HIV-infected women, reducing progression and increasing regression. As HPV disease is a common sex-specific manifestation of HIV disease this effect of HAART would be a major additional benefit from this modality of therapy. (C) 2001 Lippincott Williams & Wilkins.
引用
收藏
页码:2157 / 2164
页数:8
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