Effect of Highly Active Antiretroviral Therapy (HAART) and Menopause on Risk of Progression of Cervical Dysplasia in Human Immune-Deficiency Virus- (HIV-) Infected Women
Background. More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions (SILs) on these women. Methods. To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis. Results. Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen or no regimen (CI: 0.33–0.70, ). A greater increase of CD4+ cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11–2.62, ), adjusting for HIV medications, CD4+ count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking. Conclusion. HAART had a positive long-term effect on the progression to SILs. However, being younger and menopausal increases the risk of progression. 1. Introduction HIV infection increases the risk for invasive cervical carcinoma and its precursors, SILs [1–4]. The introduction of HAART has significantly reduced morbidity and mortality in HIV-infected patients. The effect of HAART on SILs, however, has not been entirely clear. Some studies have reported a beneficial effect of HAART with increase in regression [5–8], or decrease in progression [5] of SILs. In contrast, other studies report no difference in regression [9] and progression [9, 10] of SILs, when comparing patients on HAART and those not on HAART. It should be noted that some of these studies had a short-term follow-up and the effect of HAART on SILs may not be obvious because it takes years to develop HPV-related lesions. Two seminal studies done recently showed a definitive beneficial effect of HAART on SIL in HIV-infected women; however, these studies did not assess the effect of menopause [11, 12]. The number of HIV-infected women reaching menopause and older age is expected to increase due to improved survival on HAART. To date, there have only been limited studies which focused on SIL in HIV-infected menopausal women. Therefore, it is not clear whether the general guidelines regarding cervical cancer screening [13, 14] should be applied to HIV-infected menopausal women. The purpose of this study was to assess the long-term effect of HAART and
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