THERAPY AND FOLLOW-UP OF HIV-INFECTED WOM EN WITH CERVICAL INTRAEPITHELIAL NEOPLASIA

We have been observing an increased prevalence of cervical intraepithe lial neoplasia in HIV-infected women in our department of obstetrics a nd gynaecology. 10 HIV-infected patients with cervical intraepithelial neoplasia were treated by CO2-laser - 6 were subjected to laser excis ion conisation, and 4 patients to laser vaporisation. After laser vapo risation and laser excision conisation, no postoperative complications were observed. Intraoperative bleeding was rarely seen. The preoperat ive examination of the CD4-cell count had no influence on the choice o f the applied method of laser treatment, laser vaporisation or laser e xcision conisation. But all the 4 patients with a CD4-cell count 4 les s than or equal to 200/mu l experienced recurrence of disease shortly after the first laser treatment. Only one out of five patients with CD 4-cell counts between 200-499/mu l had a recurrence of disease after l aser treatment. All in all, a recurrence of disease was seen in five o ut of ten HN-infected patients with cervical intraepithelial neoplasia . The recurrence rate is possibly increased because HIV-infected women have multifocal cervical, vulval and vaginal dysplasia more frequentl y than HIV-negative patients. In our study, we observed multifocal cer vical, vulval and vaginal dysplasia in four HIV-infected patients. The refore, an accurate short-term follow-up with colposcopy and cytologic al smears should be carried out after the treatment of HIV-infected pa tients with cervical intraepithelial neoplasia.