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

Autor: Marina la Grange, Jean B. Nachega, M H Botha, Mercia Louw, Ingrid Eshun-Wilson, Marije van Schalkwyk, Deidre Mason, Frederick H van der Merwe, Michele Zeier
Rok vydání: 2012
Předmět:
Adult
Oncology
medicine.medical_specialty
Adolescent
HIV Infections
Kaplan-Meier Estimate
Risk Assessment
Statistics
Nonparametric
Cohort Studies
South Africa
Young Adult
Age Distribution
Internal medicine
Carcinoma
Humans
Medicine
Sex Distribution
Young adult
Survival rate
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Analysis of Variance
Chi-Square Distribution
business.industry
Proportional hazards model
Incidence
Incidence (epidemiology)
Obstetrics and Gynecology
Retrospective cohort study
General Medicine
Middle Aged
Uterine Cervical Dysplasia
medicine.disease
Survival Rate
Cell Transformation
Neoplastic
Anti-Retroviral Agents
Multivariate Analysis
Immunology
Carcinoma
Squamous Cell
Disease Progression
Female
business
Precancerous Conditions
Chi-squared distribution
Cohort study
Zdroj: Journal of Lower Genital Tract Disease. 16:243-250
ISSN: 1089-2591
DOI: 10.1097/lgt.0b013e3182403d18
Popis: This study aimed to investigate the progression and persistence of low-grade squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)-infected women.Study participants for this retrospective cohort study were 1,720 women who had LSIL as their first abnormal Pap smear. A comparison of the survival of LSIL without progression to high-grade SIL as progression-free time and the survival of SIL without clearance of the lesion as persistence of SIL was done for women of HIV-positive, HIV-negative, or unknown status using the Kaplan-Meier method. Multivariable Cox proportional hazards regression model was applied to identify independent risk factors for disease progression or persistence.We found progression of LSIL not different between HIV groups but that persistence occurred more in HIV-positive women (63.8% vs 35.0%, p.001). For the HIV group, antiretroviral therapy that was started before the first LSIL was associated with decreased risk for progression compared with no antiretroviral therapy (hazard ratio = 0.66, 95% CI = 0.54-0.81, p.001). Antiretroviral therapy also improved clearance when corrected for excision treatment and age (hazard ratio = 1.71, 95% CI = 1.29-2.27, p.001). Excision of LSIL reduced the risk of progression. In HIV-negative women, progression was reduced from 54.7% to 0.0% (p.001), and from 46.9% to 6.4% in HIV-positive women (p.001). Excision also reduced persistence in HIV-negative women from 39.5% to 7.1% (p = .001), but for HIV-positive women, the effect was smaller (from 66.3% to 45.5%, p.001).Antiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.
Databáze: OpenAIRE
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