Progression and Persistence of Low-Grade Cervical Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus

Zeier, M; Botha, Matthys H.; Merwe, Frederick H van der; Eshun‐Wilson, Ingrid; Schalkwyk, Marije Van; Grange, Marina la; Mason, Deidre; Louw, Mercia; Nachega, Jean B.

doi:10.1097/lgt.0b013e3182403d18

Cited by 18 publications

(21 citation statements)

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“…The risk of developing SIL and HSIL was found to be higher in HIV positive women with severe immunosuppression, which is in support of previous studies from southern Africa, North America and Asia that reported higher prevalence of SIL among severely immune-compromised women [13]–[16]. The independent association between SIL and severe immunosuppression was retained after controlling for the use of antiretroviral drugs, confirming the independent effect of severe immunosuppression with poor clearance of HPV from cervical cells and eventual transformation of SIL to invasive cancer [14], [17], [18], Agaba et al [19] and Sewande et al [22] reported that the immunosuppressive effect, measured by the decrease in CD4 cell count, is the greatest predictor of cervical lesion development in HIV-positive women.…”

Section: Discussionsupporting

confidence: 89%

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The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

et al. 2014

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IntroductionFindings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria.MethodsA cross sectional study among 1140 women of known HIV status enrolled in a randomised study to determine the test characteristics of visual inspection in detecting cytology diagnosed squamous intraepithelial lesion. Multivariate analysis was used to determine the association between HIV infection, antiretroviral drug use and the twin outcome variables of cervical squamous intraepithelial lesion (SIL) and High grade squamous intraepithelial lesion (HSIL) while controlling for confounders.ResultsPrevalence of cervical squamous intraepithelial lesion was 8.5%, with a higher prevalence of 14.3% in HIV positive compared to 3.3% in HIV negative women (aOR: 5.4; 95% CI: 2.9–8.8). Not using antiretroviral drugs was found to be associated with an increased risk of SIL (aOR: 2.1; 95% CI: 1.4–3.5) and HSIL (aOR: 2.6; 95% CI: 1.1–6.4). Participants who had a CD4 cell count <200 cells/mm3, were also found to be at increased risk for SIL (aOR: 1.9; 95% CI: 1.1–5.9) and HSIL (aOR: 5.7; 95% CI: 1.1–7.2).ConclusionHIV infection and severe immunosuppression were found to be associated with increased risk of cervical squamous intraepithelial lesion but not viral load. For the first time, in the West African sub-region with specific HIV type and strains, we established the protective effect of antiretroviral drug use against the development of SIL. Integration of cervical cancer screening programme into HIV services and early initiation of antiretroviral drug in HIV positive women especially those with severe immune-suppression could therefore prove to be useful in preventing and controlling cervical cancer development in HIV positive women.

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Section: Discussionsupporting

confidence: 89%

“…Despite availability of studies that examined the effects of antiretroviral drug use on the course of cervical lesions in HIV positive women, the impact of the use of antiretroviral drug on the course of cervical lesions remains somewhat unclear [7]–[13]. While some studies [10]–[12], [15], [16].…”

Section: Introductionmentioning

confidence: 99%

The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

et al. 2014

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“…Ten studies reported the association of ART with cytology diagnosed SIL incidence, 15 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 and two studies with histology diagnosed HSIL-CIN2+ incidence 17 , 63 from a combined total of 5096 women ( table 1 ). We included ten studies 31 , 54 , 55 , 61 , 64 , 65 , 66 , 67 , 68 , 69 for cytology diagnosed SIL progression from a combined total of 6212 women, and ten studies 15 , 31 , 54 , 61 , 64 , 67 , 68 , 70 , 71 , 72 for regression of histology diagnosed CIN or cytology diagnosed SIL from a combined total of 5261 women ( table 1 ). Only one study reported the regression from histological CIN grade 1 to normal.…”

Section: Resultsmentioning

confidence: 99%

Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis

et al. 2018

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SummaryBackgroundThe interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes.MethodsWe did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I2 statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546).FindingsWe identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0·83, 95% CI 0·70–0·99; I2=51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0·65, 0·40–1·06; I2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0·59, 0·40–0·87; I2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0·64, 95% CI 0·54–0·75; I2=18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1·54, 1·30–1·82; I2=0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0·40, 95% CI 0·18–0·87, I2=33%).InterpretationEarly ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect.FundingUK Medical Research Council.

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“…35 In terms of evolution of SIL lesions, data are more supportive of an effect of cART on the progression of SIL lesions. 33, 36 Minkoff and colleagues 37 showed that, among 286 women enrolled in the WIHS cohort who initiated cART, adherence to cART resulted in a significant reduction of SIL (OR 5 2.25; 95% CI 5 1.03-4.93) compared with before cART. Further longitudinal studies with more uniform methods and outcome definitions are needed to assess the effect of cART on HPV infection as well as SIL progression, persistence, or regression.…”

Section: Effect Of Cart On Hpv Persistence and Evolution Of Precancermentioning

confidence: 96%

Cervical Cancer Screening in Immunocompromised Women

Nguyen

Flowers

2013

Obstetrics and Gynecology Clinics of North America

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Progression and Persistence of Low-Grade Cervical Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus

Abstract: Antiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.

Cited by 18 publications

References 25 publications

The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis

Cervical Cancer Screening in Immunocompromised Women

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