Impact of timing of antiretroviral therapy initiation on survival of cervical squamous intraepithelial lesions: A cohort analysis from South Africa

M. D. Zeier, J. B. Nachega, F. H. Van Der Merwe, I. Eshun-Wilson, M. Van Schalkwyk, M. La Grange, D. Mason, M. Louw, M. H. Botha

Research output: Contribution to journalArticle

Abstract

To determine factors that influence excision treatment outcome and recurrence of cervical squamous intraepithelial lesions (SIL) in women living with HIV infection, we analysed 1848 women who underwent excision treatment of cervical SIL at Tygerberg Hospital, Cape Town, South Africa. We compared treatment failure defined as presence of cervical intraepithelial neoplasia (CIN) I (presence of CIN I or higher at first follow-up after excision treatment) and post-excision recurrence of lesions (at one year or later) between women of HIV-positive, -negative or unknown status and examined factors associated with excision treatment outcome and recurrence. HIV-infected women experienced higher treatment failure than uninfected women (53.8% versus 26.9%, P < 0.001). At treatment failure, more HIV-infected women had low-grade squamous intraepithelial lesion (LSIL) compared with uninfected women (64.9% versus 37.3%, P < 0.001). Treatment failure did not differ with the type of excision used in HIV-infected women. HIV-infected women were more likely to experience recurrence of lesions after excision treatment than uninfected women (hazard ratio 1.95, 95% confidence interval [CI] 1.59-2.39; P < 0.001). Antiretroviral therapy (ART) initiated before excision biopsy had a strong protective effect against recurrence (hazard ratio 0.70, 95% CI 0.55-0.89; P = 0.006). Our data suggest that women with cervical SIL initiated on ART earlier may be expected to have better long-term excision treatment outcome. Close follow-up should be maintained after cervical excision treatment, especially in a setting of high HIV prevalence.

Original languageEnglish (US)
Pages (from-to)890-896
Number of pages7
JournalInternational Journal of STD and AIDS
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2012

Keywords

  • AIDS
  • Antiretroviral treatment
  • CIN
  • Excision treatment outcome
  • HIV
  • HPV
  • Recurrence
  • SIL
  • Squamous intraepithelial lesions
  • Women

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Pharmacology (medical)
  • Infectious Diseases

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  • Cite this

    Zeier, M. D., Nachega, J. B., Van Der Merwe, F. H., Eshun-Wilson, I., Van Schalkwyk, M., La Grange, M., Mason, D., Louw, M., & Botha, M. H. (2012). Impact of timing of antiretroviral therapy initiation on survival of cervical squamous intraepithelial lesions: A cohort analysis from South Africa. International Journal of STD and AIDS, 23(12), 890-896. https://doi.org/10.1258/ijsa.2012.012040