Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia

Abstract

Suppressive ART is associated with effective treatment of CIN2+. Early HIV diagnosis and ART are essential for successful CIN2+ treatment.

Antiretroviral Therapy and Detection of High-grade Cervical Intraepithelial Neoplasia (CIN2+) at Post-CIN Management Follow-up Among Women Living With Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis

“…Four hundred and four records were identified, of which 128 duplicates were removed, and 230 records were excluded after title/abstract review, leaving 43 articles for full-text review (Figure 1). Of these, 8 articles [21][22][23][24][25][26][27][28] , representing 9 discrete populations and 1,452 women, met the inclusion criteria. One study [24] provided separate effect estimates for two populations: WLHIV who received cryotherapy and WLHIV who received excisional therapy.…”

“…The proportion of ART users ranged between 65% and 92%; between 53% and 65% of WLHIV had HIV PVL <50 copies/ml and median CD4+ cell counts ranged from 322 cells/µl to 557 cells/µl. Of the three populations that studied the association of ART and CIN2+ detection at follow-up in HMICs [22,25,28] , excisional management methods were used in one [28] and a combination of excision and ablative methods were used in two, although most women were treated using excisional methods (77% and 85%) [22,25] . Of the five populations evaluated in LMICs, excision and ablative methods were used in two [24,26] and three [23,24,27] populations respectively (Table 1).…”

“…Seven studies, representing 8 populations and 1, 408 women assessed the association of ART use and CIN2+ detection at follow-up [22][23][24][25][26][27][28] There was weak evidence of a decrease in CIN2+ detection at follow-up among ART users compared to ART-naïve women (crude OR [cOR]=0.70, 95% confidence interval [CI]: 0.36-1.36; I 2 =64.5%, p=0.006; Figure 2). Three studies [25][26][27] provided adjusted values and when pooled together did not significantly modify the estimate (cRR=0.66, 95%CI: 0.20-2.24; I 2 =78.7%, p=0.009; adjusted for age, CD4+ cell count and WHO clinical stage; data not shown).…”

“…There was a significantly decreased risk in CIN2+ detection at follow-up among ART users in studies conducted in high and upper middle-income countries (HMICs) [22,25,28] (cOR=0.24, 95%CI: 0.13-0.45; I 2 =0.0%, p=0.77; Table 2, Appendix C) but not in low and lower middle-income countries (LMICs) [23,24,26,27] (cOR=1.13, 95%CI: 0.67-1.92; I 2 =18.8%, p=0.30; Table 2, Appendix C ).…”

Antiretroviral treatment for HIV infection: Swedish recommendations 2019

“…Women living with HIV in Sweden have a more than nine-fold increased risk of high-grade cervical dysplasia (cervical intraepithelial neoplasia grade 2 or worse [HSIL/CIN2þ]) [59]. Access to effective ART and retained immune system (CD4 > 500 cells/ml) is associated with a reduced risk of dysplasia and better outcomes after treatment (conization) of these [60,61]. Women who live with HIV and have normal cytology tests as well as negative HPV tests show the same low risk as HIV-negative women to develop severe dysplasia, regardless of CD4 level, after 5 years of follow-up [62].…”