AEGiS-13IAC: Incidence of recurrent cervical dysplasia in HIV positive women after cervical excisional treatment.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Incidence of recurrent cervical dysplasia in HIV positive women after cervical excisional treatment.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB237)

Keller JM, Sewell C, Anderson J
J.M. Keller, Johns Hopkins University, 600 N Wolfe Street, Harvey 319, Baltimore, MD 21287, United States, Tel.: +1 410 614 4496, Fax: +1 410 955 1003, E-mail: jkeller@jhmi.edu

BACKGROUND: HIV+ women have demonstrated increased recurrence rates after treatment for cervical dysplasia(CD). This study evaluates CD recurrence rates after excisional cervical treatment, with stratification by CD4 count, viral load, and pathology results.

METHODS: Retrospective review of HIV+ women between 1995 and 1999 with cervical conization(CC) or large loop excision of the transformation zone(LLETZ) for CD with at least one follow up(f/u) pap smear or biopsy. Summary statistics, fishers exact, and chi-square were performed.

RESULTS: 39 cases were reviewed, including 61.5% with CC and 38.5% LLETZ. Mean age: 34.3; Race: Afro-American- 69.2%, Caucasian 28.2%, and Hispanic 2.6%. CD4 counts (n = 38) at f/u: >51- 26.3%; 51-200- 18.4%; >200- 55.3%. Surgical pathology revealed 76.9% with high grade squamous intra-epithelial lesion (HSIL) and positive margins (n = 32) in 19(59.4%). Endocervical curettage(ECC) was positive in 5 patients, all with positive margins. F/u pap or biopsy

RESULTS: normal(nml): 46.2%; Atypical squamous cells (ASCUS)- 23.1%; Low grade squamous intra-epithelial lesion(LSIL)- 20.4%; HSIL- 10.3%. The mean time to f/u was 14.8 months overall, 16.7 for nml, and 13.2 for abnormal. Positive margins, mean CD4, CD4>51 or >200 were not significantly associated with abnormal f/u. Patients with HIV-RNA >400 c/ml vs. >401 were more likely to have abnormal f/u (80% vs. 33.3%), p = 0.01). Mean HIV-RNA was 155,126 for abnormal vs. 43,567 with nml f/u (p = 0.05).

CONCLUSION: Detectable HIV-RNA and higher mean HIV-RNA levels were significantly associated with recurrent cervical abnormality after excisional treatment. Small numbers preclude definitive conclusions re: association of surgical margins and CD4 in likelihood of recurrence. Appropriate antiretroviral therapy may be an important adjuvant in managing cervical dysplasia in HIV positive women.

Keywords: AEGIS, Cervix Dysplasia, Incidence, Cervical Intraepithelial Neoplasia, HIV, Vaginal Smears, Conization, Cervix Uteri, HIV Seropositivity, CD4 Lymphocyte Count, HIV Infections, Viral Load, Biopsy, Electrosurgery, Retrospective Studies, HIV Seronegativity, Dilatation and Curettage, Human, Female, therapy, epidemiology, surgery, immunology
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MoOrB237