MULTIPLE RECURRENCES OF CERVICAL INTRAEPITHELIAL NEOPLASIA IN WOMEN WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: To evaluate the long-term outcomes after treatment of cervi cal intraepithelial neoplasia (CIN) in women infected with the human i mmunodeficiency virus (HIV). Methods: Human immunodeficiency virus-inf ected and HIV-negative women treated for CIN by ablation or excision w ere followed-up prospectively by cytology and colposcopy for periods o f up to 73 months. Results: Among 127 HIV-infected CIN patients, 62% d eveloped recurrent CIN by 36 months after treatment, compared with 18% of 193 HIV-negative CIN patients. Recurrence rates reached 87% in 41 HIV-infected women with CD4 counts less than 200 cells/mm(3). Progress ion to higher-grade neoplasia, including one invasive cancer, occurred by 36 months in 25% of HIV-infected and 2% of HIV-negative women. Aft er adjusting for age, CIN severity, and treatment type, predictors of recurrence included HIV infection (rate ratio 4.4), and, in HIV-positi ve women, low CD4 count (rate ratio 2.2). In patients treated by excis ion, predictors of recurrence included HIV infection (rate ratio 2.0) and residual CIN after treatment (rate ratio 2.7). After a second trea tment, 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 follo w-up, 45% of treated HIV-infected CIN patients had chronic condylomato us changes in the cervix compared with 5% of HIV-negative women. Concl usion: In HIV-infected women, CIN may recur despite multiple treatment s, and chronic condylomatous changes are common. Innovative therapies for controlling CIN in HIV-infected women are needed.