Limited Impact of Immunosuppression and Haart on the Incidence of Cervical Squamous Intraepithelial Lesions in HIV-Positive Women

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Abstract
Background: Although highly active antiretroviral therapy (HAART) has lowered the incidence of various opportunistic diseases, its impact on cervical squamous intraepithelial lesions (SILs) is unclear. Our objective was to compare the incidence of SILs in HIV-infected women receiving HAART versus those not receiving HAART and to determine the role of risk factors including immunosuppression in the pathogenesis of SIL. Methods: A total of 298 HIV-infected women with normal Papanicolaou (Pap) smear and normal colposcopic findings at enrollment were followed-up until incident SIL or last follow-up visit. Cox regression modelling was used to assess risks factors for incident SIL. Results: Eighty-eight women developed SILs, including 75 low-grade lesions, during a median follow-up of 28 months (16–52; incidence of 8.7 cases per 100 person-years). No invasive cervical cancers were identified. Incidence decreased from 10.7 to 6.5 per 100 person-years in non-receiving versus receiving HAART women (relative risk [RR]: 0.7; 95% confidence interval [CI]: 0.4–1.2, P=0.15, from the adjusted Cox model). Incident SIL was not associated to low CD4+ T-cell count ( P=0.54). In multivariate analysis, the only significant risk factor for incident lesion was the age between 30–39 compared with over 40 (RR: 3.5; 95% CI: 1.4–8.9; P=0.02). Conclusion: No impact in the development of SIL was evidenced for CD4+ T-cell counts, but we cannot exclude a modest impact of HAART. All HIV-positive women should be offered to participate in cervical cancer screening programmes whether or not they receive effective antiretroviral therapy.