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Incidence of Cervical Squamous Intraepithelial Lesions Associated With HIV Serostatus, CD4 Cell Counts, and Human Papillomavirus Test Results
Tiffany G. Harris, PhD;
Robert D. Burk, MD;
Joel M. Palefsky, MD;
L. Stewart Massad, MD;
Ji Yon Bang, MS;
Kathryn Anastos, MD;
Howard Minkoff, MD;
Charles B. Hall, PhD;
Melanie C. Bacon, RN, MPH;
Alexandra M. Levine, MD;
D. Heather Watts, MD;
Michael J. Silverberg, MPH, PhD;
Xiaonan Xue, PhD;
Sandra L. Melnick, DrPH;
Howard D. Strickler, MD, MPH
JAMA. 2005;293:1471-1476.
Context Recent cervical cancer screening guidelines state that the interval between screenings can be safely extended to 3 years in healthy women 30 years or older who have normal cytology results and have negative test results for oncogenic human papillomavirus (HPV) DNA.
Objective To determine the incidence of squamous intraepithelial lesions (SILs) in HIV-seropositive women with normal cytology results, by baseline HPV DNA results.
Design, Setting, and Patients Participants were HIV-seropositive (n = 855; mean age, 36 years) and HIV-seronegative (n = 343; mean age, 34 years) US women with normal baseline cervical cytology who were enrolled in the Women’s Interagency HIV Study (WIHS), a large, multi-institutional prospective cohort study. Since their recruitment during 1994-1995, WIHS participants have been followed up semi-annually with repeated Pap smears for a median of 7 years.
Main Outcome Measure The cumulative incidence of any SIL and high-grade SIL or cancer (HSIL+) was estimated according to baseline HPV DNA results, stratified by HIV serostatus and CD4 T-cell count.
Results Development of any SIL in women with negative HPV results (both oncogenic and nononcogenic) at 2 years was as follows: in HIV-seropositive women with CD4 counts less than 200/µL, 9% (95% CI, 1%-18%); with CD4 counts between 200/µL and 500/µL, 9% (95% CI, 4%-13%); and with CD4 counts greater than 500/µL, 4% (95% CI, 1%-7%). The CIs for these estimates overlapped with those for HIV-seronegative women with normal baseline cytology who were HPV-negative (3%; 95% CI, 1%-5%), indicating that at 2 years, there were no large absolute differences in the cumulative incidence of any SIL between groups. Furthermore, no HPV-negative participants in any group developed HSIL+ lesions within 3 years. Multivariate Cox models showed that on a relative scale, the incidence of any SIL among HIV-seropositive women with CD4 counts greater than 500/µL (hazard ratio [HR], 1.2; 95% CI, 0.5-3.0), but not those with CD4 counts less than or equal to 500/µL (HR, 2.9; 95% CI, 1.2-7.1), was similar to that in HIV-seronegative women.
Conclusion The similar low cumulative incidence of any SIL among HIV-seronegative and HIV-seropositive women with CD4 counts greater than 500/µL and who had normal cervical cytology and HPV-negative test results suggests that similar cervical cancer screening practices may be applicable to both groups, although this strategy warrants evaluation in an appropriate clinical trial.
Author Affiliations: Albert Einstein College of Medicine, Bronx, NY (Drs Harris, Burk, Anastos, Hall, Xue, and Strickler and Ms Bang); University of California, San Francisco (Dr Palefsky); Southern Illinois University School of Medicine, Springfield (Dr Massad); Maimonides Medical Center, Brooklyn, NY (Dr Minkoff); Georgetown University Medical Center, Washington, DC (Ms Bacon); University of Southern California, Los Angeles (Dr Levine); National Institute of Child Health and Human Development, Bethesda, Md (Dr Watts); Johns Hopkins University, Baltimore, Md (Dr Silverberg); and National Cancer Institute, Bethesda, Md (Dr Melnick). Ms Bacon is now with the National Institute of Allergy and Infectious Diseases, Bethesda, Md, Dr Silverberg is now with Kaiser Permanente, Oakland, Calif, and Dr Melnick is now with the Center for Scientific Review, Bethesda, Md.
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