Natural History of Cervical Intraepithelial Neoplasia-2 in HIV-Positive Women of Reproductive Age

• Type of Material: Article
• Authors: Christine Colie, Georgetown University; Katherine G. Michel, Georgetown University; L. Stewart Massad, Washington University in St. Louis; Cuiwei Wang, Georgetown University; Gypsyamber D'Souza, Johns Hopkins University; Lisa Rahangdale, University of North Carolina; Lisa Flowers, Emory University; Joel Milam, University of Southern California; Joel M. Palefsky, University of California San Francisco; Howard Minkoff, Maimonides Hospital; Howard D. Strickler, Albert Einstein College of Medicine; Seble G. Kassaye, Georgetown University
• Language: English
• Date: 2018-12-15
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001865
• Title of Journal or Parent Work: JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
• Volume: 79
• Issue: 5
• Start Page: 573
• End Page: 579
• Grant/Funding Information: WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).
• Keywords: HIV; Science & Technology; disease progression; CANCER; REGRESSION; DISEASE; MANAGEMENT; CD4 lymphocyte count; RISK; cervix; prospective studies; cohort studies; cervical intraepithelial neoplasia; BIRTH; Life Sciences & Biomedicine; Infectious Diseases; HUMAN-IMMUNODEFICIENCY-VIRUS; antiretroviral therapy; LESIONS; ACTIVE ANTIRETROVIRAL THERAPY; HUMAN-PAPILLOMAVIRUS INFECTION; Immunology
• Research Categories: Biology, Virology; Health Sciences, Obstetrics and Gynecology; Health Sciences, Immunology; Health Sciences, Oncology

Abstract

Objective: To evaluate the natural history of treated and untreated cervical intraepithelial neoplasia-2 (CIN2) among HIV-positive women. Methods: Participants were women enrolled in the Women's Interagency HIV Study between 1994 and 2013. One hundred four HIV-positive women diagnosed with CIN2 before age 46 were selected, contributing 2076 visits over a median of 10 years (interquartile range 5-16). The outcome of interest was biopsy-confirmed CIN2 progression, defined as CIN3 or invasive cervical cancer. CIN2 treatment was abstracted from medical records. Results: Most women were African American (53%), current smokers (53%), and had a median age of 33 years at CIN2 diagnosis. Among the 104 HIV-positive women, 62 (59.6%) did not receive CIN2 treatment. Twelve HIV-positive women (11.5%) showed CIN2 progression to CIN3; none were diagnosed with cervical cancer. There was no difference in the median time to progression between CIN2-treated and CIN2-untreated HIV-positive women (2.9 vs. 2.7 years, P = 0.41). CIN2 treatment was not associated with CIN2 progression in multivariate analysis (adjusted hazard ratio 1.82; 95% confidence interval: 0.54 to 7.11), adjusting for combination antiretroviral therapy and CD4+ T-cell count. In HIV-positive women, each increase of 100 CD4+ T cells was associated with a 33% decrease in CIN2 progression (adjusted hazard ratio 0.67; 95% confidence interval: 0.47 to 0.88), adjusting for CIN2 treatment and combination antiretroviral therapy. Conclusions: CIN2 progression is uncommon in this population, regardless of CIN2 treatment. Additional studies are needed to identify factors to differentiate women at highest risk of CIN2 progression.