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

Objective Cervical intraepithelial neoplasia (CIN), a common condition amon g HIV-infected women, has been linked to HIV load and immune status. Highly active antiretroviral therapy (HAART) improves immunologic and virologic s tatus. This study was undertaken to determine the relationship between HAAR T use and CIN. Design Cohort study. The Women's Interagency HIV Study (WINS) in five citie s in the USA (Bronx/Manhattan, New York; Brooklyn, New York; Chicago, Illin ois; Los Angeles, California; San Francisco Bay area, California; Washingto n, District of Columbia). Methods HIV-infected women were followed every 6 months with Papanicolaou s mears and cervicovaginal lavage for human papillomavirus (HPV) DNA testing. To characterize exposures that changed over time and to capture the dynami c nature of cytologic changes, Papanicolaou smear findings from each partic ipant's consecutive visits were defined as a pair. We determined the propor tion of all pairs that exhibited either regression or progression, accordin g to HAART exposure, HPV results and Papanicolaou smear status. As particip ants could contribute multiple pairs, inferences were based on robust metho ds to adjust for correlated observations. Results Women with persistent HPV infection were more likely to have progre ssion of their lesions. After adjustment for CD4 cell count and Papanicolao u smear status, women on HAART were 40% (95% confidence interval, 4-81%) mo re 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 m ajor additional benefit from this modality of therapy. (C) 2001 Lippincott Williams & Wilkins.