Evolution of Cervical Cytologic Changes among HIV-Infected Women with Normal Cytology in the HAART Era

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Abstract
The influence of HAART on the evolution to cervical squamous intraepithelial lesions (SIL) among HIV+ women with a normal cytological test in the HAART era was studied. A retrospective cohort study (1997–2005) of HIV-infected women treated with HAART was conducted. Those with a normal cervical cytology (Papanicolaou test) and at least one subsequent test were included. Survival (time until diagnosis of SIL), univariate, and multivariate analyses were performed. A total of 133 HIV-infected patients treated with HAART were included. The incidence of SIL was 35% (47 patients). SIL was diagnosed in 36 of 110 (33%) patients with a baseline and final immunological status of >200 CD4 cells/μl and in 6 of 9 (67%) patients with a baseline and final immunological status of ≤200 CD4 (OR: 0.24, 95% CI: 0.06–1.03, p = 0.041). SIL was diagnosed in 10 of 60 (17%) patients with an undetectable baseline and final HIV viral load and in 36 of 70 (51%) patients with a detectable HIV viral load (OR: 0.19, 95% CI: 0.07–0.46, p < 0.001). A high incidence of SIL (cancer precursor lesions) was observed among HIV+ women without a background of cervical pathology. The effect of HAART on the control of HIV replication and of immunological status (>200 CD4) through the follow-up was associated with a reduction of SIL.