Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immunodeficiency virus

OBJECTIVE: Our purpose was to determine the rates of recurrence, persistenc e, and progression of cervical intraepithelial neoplasia in women who were seropositive for human immunodeficiency virus after excisional therapy with and without highly active antiretroviral therapy. STUDY DESIGN: The records of 118 women with cervical intraepithelial neopla sia, 56 of whom were infected with human immunodeficiency virus and 62 of w hom were not infected, were examined to compare outcomes. Demographic, beha vioral, and clinical indices were analyzed. RESULTS: Of 54 women infected with human immunodeficiency virus, 31 (57.4%) had persistent or recurrent cervical intraepithelial neoplasia, in compari son with 10 (16.7%) of 60 noninfected women (P<.01). Progression occurred i n 4 (16.7%) of 54 in the infected group and in 3 (5.0%) of 60 in the noninf ected group (P<.05). In 21 (60.0%) of 35 infected women, in comparison with 8 (32%) of 25 noninfected women, disease persisted 6 months after diagnosi s if treatment was not given (P<.05). Of 19 infected women, 10 (52.6%) had recurrent disease after treatment, compared with 2 (5.7%) of 35 noninfected women (P<.01). Risk factors for recurrence in women who were seropositive for human immunodeficiency virus included margin involvement of specimens o btained by loop electrosurgical excision (87.5% vs 20.0%l; P<.05). Exposure to highly active antiretroviral therapy, including therapy with protease i nhibitors, was associated with a lower recurrence or persistence rate (17.6 % vs 70.3%; P<.05) and a lower progression rate (0% vs 24%; P<.05). CONCLUSION: Women infected with human immunodeficiency virus had high rates of recurrent and persistent cervical intraepithelial neoplasia despite sta ndard therapy. Low CD4(+) levels and margin involvement of specimens obtain ed by loop electrosurgical excision are risk factors for recurrence. The us e of highly active antiretroviral therapy is associated with a lower risk o f recurrence, persistence, and progression of cervical intraepithelial neop lasia.