TY - JOUR
T1 - Influence of adherent and effective antiretroviral therapy use on human papillomavirus infection and squamous intraepithelial lesions in human immunodeficiency virus-Positive women
AU - Minkoff, Howard
AU - Zhong, Ye
AU - Burk, Robert D.
AU - Palefsky, Joel M.
AU - Xue, Xiaonan
AU - Watts, D. Heather
AU - Levine, Alexandra M.
AU - Wright, Rodney L.
AU - Colie, Christine
AU - D'Souza, Gypsyamber
AU - Massad, L. Stewart
AU - Strickler, Howard D.
N1 - Funding Information:
Financial support: National Cancer Institute (grant R01-CA-085178 to H.D.S. for human papillomavirus DNA testing and other cofunding); National Institute of Allergy and Infectious Diseases (grants UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590 to the Women’s Interagency HIV Study); National Institute of Child Health and Human Development (grant UO1-HD-32632); National Institute on Drug Abuse; National Institute on Deafness and Other Communication Disorders; National Center for Research Resources (grant UL1 RR024131 to the Clinical and Translational Science Institute, University of California, San Francisco).
PY - 2010/3/1
Y1 - 2010/3/1
N2 - Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods: Human immunodeficiency virus (HIV)-positive women (Np286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ≥95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results:. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44-0.81]; Pp.001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30-0.82]; Pp.006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07-5.18]; Pp.03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion:. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.
AB - Background: The impact of highly active antiretroviral therapy (HAART) on the natural history of human papillomavirus (HPV) remains uncertain following conflicting reports. Prior studies, however, did not consider patients' adherence to their regimens or HAART effectiveness (viral suppression). Methods: Human immunodeficiency virus (HIV)-positive women (Np286) who initiated HAART during follow-up in a prospective cohort were assessed semiannually for HPV infection (by polymerase chain reaction) and squamous intraepithelial lesions (SILs). Adherence was defined as use of HAART as prescribed ≥95% of the time, and effective HAART was defined as suppression of HIV replication. The prevalence, incident detection, and clearance of HPV infection and/or SILs before versus after HAART initiation were compared (using women as their own comparison group). Results:. HAART initiation among adherent women was associated with a significant reduction in prevalence (odds ratio, 0.60 [95% confidence interval {CI}, 0.44-0.81]; Pp.001), incident detection of oncogenic HPV infection (hazard ratio [HR], 0.49 [95% CI, 0.30-0.82]; Pp.006), and decreased prevalence and more rapid clearance of oncogenic HPV-positive SILs (HR, 2.35 [95% CI, 1.07-5.18]; Pp.03). Effects were smaller among nonadherent women. The associations of HPV infection and/or SILs with HAART effectiveness were fairly similar to those with HAART adherence. Conclusion:. Effective and adherent HAART use is associated with a significantly reduced burden of HPV infection and SILs; this may help explain why rates of cervical cancer have not increased during the HAART era, despite greater longevity.
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U2 - 10.1086/650467
DO - 10.1086/650467
M3 - Article
C2 - 20105077
AN - SCOPUS:76449119189
SN - 0022-1899
VL - 201
SP - 681
EP - 690
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 5
ER -