EARLY REGRESSION OF CERVICAL LESIONS IN HIV-SEROPOSITIVE WOMEN RECEIVING HIGHLY-ACTIVE ANTIRETROVIRAL THERAPY

Objective: Advanced HIV disease is associated with a high prevalence o f cervical squamous intra-epithelial lesions (SIL) and of infection wi th oncogenic human papillomavirus (HPV) genotypes. Triple-combination antiretroviral therapy results in decreased plasma HIV viral load, inc reased CD4 cell counts and partial restoration of immune functions in patients with severe HIV disease. This study investigated the outcome of SIL in HIV-seropositive women undergoing triple combination antiret roviral treatment. Methods: Forty-nine women who started triple-combin ation antiretroviral therapy, including a protease inhibitor, were exa mined prior to and after a median 5-month treatment. We collected cyto logical, colposcopic and histologic data and assessed the presence of HPV DNA in cervical smears by PCR and Southern blot hybridization (SBH ). Results: The prevalence of SIL decreased from 69 to 53% during foll ow-up (P < 0.0001). Among 13 women who initially presented with high-g rade SIL, conversion to lower grade was observed in two women and a fu ll regression to normality was observed in one. Cytology also returned to normality in nine out of 21 women who initially presented with low -grade SIL. The high prevalence of HPV infection as detected by SBH an d PCR was similar at the first and second examinations and the same hi gh-risk viral genotypes were identified at both examinations in all in fected patients but one. There was a higher increase in absolute CD4 c ells in the subgroup of patients whose lesions regressed (99 versus 50 x 10(6)/l, P = 0.03). Conclusion: Our observations demonstrate that a ctive antiretroviral therapy may result in a reduced prevalence of cer vical squamous intra-epithelial lesions despite the absence of clearan ce of HPV infection. (C) 1998 Lippincott-Raven Publishers.