Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto: A prospective cohort

Tanvier Omar, Sheree Schwartz, Colleen Hanrahan, Tebogo Modisenyane, Nkeko Tshabangu, Jonathan E Golub, James A. McIntyre, Glenda E. Gray, Lerato Mohapi, Neil A. Martinson

Research output: Contribution to journalArticle

Abstract

Objective: To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto. Design: Prospective cohort. Methods: Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system. Those with high-grade lesions or worse were referred for colposcopy. Progression analyses included women with at least two smears at least 5.5 months apart. Hazard ratios were used to ascertain predictors of progression. Results: Two thousand, three hundred and twenty-five women had a baseline smear; their median age and CD4 cell count was 32 years and 312 cells/μl, respectively; 17% were taking highly active antiretroviral therapy (HAART); 62, 20 and 14% had normal, low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), respectively. Of those with baseline normal or LSIL smears, 1074 had another smear; progression from normal to LSIL was 9.6/100 person-years (95% CI 8.3-11.1) and progression from normal or LSIL to HSIL was 4.6/100 person-years (95% CI 3.9-5.5). Of 225 women with LSIL at baseline and at least one subsequent smear at least 11.5 months later, 44.0% regressed to normal (21.2/100 person-years (95% CI 17.5-25.7)). Multivariate models suggested increasing risk for progression in women with CD4 cell count below 500 cells/μl and HAART may reduce the risk of progression [adjusted hazard ratio (aHR) 0.72 (0.52-0.99)]. Conclusion: HIV-infected women have high rates of prevalent and incident HSIL and LSIL with relatively low risk of regression to normal from LSIL. HAART appears to protect against progression. Our findings suggest cervical screening intervals should be less than 10 years - irrespective of age in women with CD4 cell counts below 500 cells/μl.

Original languageEnglish (US)
Pages (from-to)87-94
Number of pages8
JournalAIDS
Volume25
Issue number1
DOIs
StatePublished - Jan 2 2011

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HIV
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Squamous Intraepithelial Lesions of the Cervix
Uterine Cervical Dysplasia
Colposcopy
Vaginal Smears

Keywords

  • antiretroviral therapy
  • CD4
  • cervical cancer
  • cohort
  • HPV
  • squamous intraepithelial lesion

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto : A prospective cohort. / Omar, Tanvier; Schwartz, Sheree; Hanrahan, Colleen; Modisenyane, Tebogo; Tshabangu, Nkeko; Golub, Jonathan E; McIntyre, James A.; Gray, Glenda E.; Mohapi, Lerato; Martinson, Neil A.

In: AIDS, Vol. 25, No. 1, 02.01.2011, p. 87-94.

Research output: Contribution to journalArticle

Omar, Tanvier ; Schwartz, Sheree ; Hanrahan, Colleen ; Modisenyane, Tebogo ; Tshabangu, Nkeko ; Golub, Jonathan E ; McIntyre, James A. ; Gray, Glenda E. ; Mohapi, Lerato ; Martinson, Neil A. / Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto : A prospective cohort. In: AIDS. 2011 ; Vol. 25, No. 1. pp. 87-94.
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T1 - Progression and regression of premalignant cervical lesions in HIV-infected women from Soweto

T2 - A prospective cohort

AU - Omar, Tanvier

AU - Schwartz, Sheree

AU - Hanrahan, Colleen

AU - Modisenyane, Tebogo

AU - Tshabangu, Nkeko

AU - Golub, Jonathan E

AU - McIntyre, James A.

AU - Gray, Glenda E.

AU - Mohapi, Lerato

AU - Martinson, Neil A.

PY - 2011/1/2

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N2 - Objective: To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto. Design: Prospective cohort. Methods: Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system. Those with high-grade lesions or worse were referred for colposcopy. Progression analyses included women with at least two smears at least 5.5 months apart. Hazard ratios were used to ascertain predictors of progression. Results: Two thousand, three hundred and twenty-five women had a baseline smear; their median age and CD4 cell count was 32 years and 312 cells/μl, respectively; 17% were taking highly active antiretroviral therapy (HAART); 62, 20 and 14% had normal, low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), respectively. Of those with baseline normal or LSIL smears, 1074 had another smear; progression from normal to LSIL was 9.6/100 person-years (95% CI 8.3-11.1) and progression from normal or LSIL to HSIL was 4.6/100 person-years (95% CI 3.9-5.5). Of 225 women with LSIL at baseline and at least one subsequent smear at least 11.5 months later, 44.0% regressed to normal (21.2/100 person-years (95% CI 17.5-25.7)). Multivariate models suggested increasing risk for progression in women with CD4 cell count below 500 cells/μl and HAART may reduce the risk of progression [adjusted hazard ratio (aHR) 0.72 (0.52-0.99)]. Conclusion: HIV-infected women have high rates of prevalent and incident HSIL and LSIL with relatively low risk of regression to normal from LSIL. HAART appears to protect against progression. Our findings suggest cervical screening intervals should be less than 10 years - irrespective of age in women with CD4 cell counts below 500 cells/μl.

AB - Objective: To ascertain progression and regression of cervical dysplasia in HIV-infected women in Soweto. Design: Prospective cohort. Methods: Women attending an HIV wellness clinic were offered cervical smears as part of care; smears were assessed using the Bethesda system. Those with high-grade lesions or worse were referred for colposcopy. Progression analyses included women with at least two smears at least 5.5 months apart. Hazard ratios were used to ascertain predictors of progression. Results: Two thousand, three hundred and twenty-five women had a baseline smear; their median age and CD4 cell count was 32 years and 312 cells/μl, respectively; 17% were taking highly active antiretroviral therapy (HAART); 62, 20 and 14% had normal, low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL), respectively. Of those with baseline normal or LSIL smears, 1074 had another smear; progression from normal to LSIL was 9.6/100 person-years (95% CI 8.3-11.1) and progression from normal or LSIL to HSIL was 4.6/100 person-years (95% CI 3.9-5.5). Of 225 women with LSIL at baseline and at least one subsequent smear at least 11.5 months later, 44.0% regressed to normal (21.2/100 person-years (95% CI 17.5-25.7)). Multivariate models suggested increasing risk for progression in women with CD4 cell count below 500 cells/μl and HAART may reduce the risk of progression [adjusted hazard ratio (aHR) 0.72 (0.52-0.99)]. Conclusion: HIV-infected women have high rates of prevalent and incident HSIL and LSIL with relatively low risk of regression to normal from LSIL. HAART appears to protect against progression. Our findings suggest cervical screening intervals should be less than 10 years - irrespective of age in women with CD4 cell counts below 500 cells/μl.

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