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. 2010 Oct;119(1):92-7.
doi: 10.1016/j.ygyno.2010.06.012.

Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women

Laura L Reimers  1 , Susan Sotardi, David Daniel, Lydia G Chiu, Anne Van Arsdale, Daryl L Wieland, Jason M Leider, Xiaonan Xue, Howard D Strickler, David J Garry, Gary L Goldberg, Mark H Einstein
Affiliations

Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women

Laura L Reimers et al. Gynecol Oncol. 2010 Oct.

Abstract

Objective: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women.

Methods: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up.

Results: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15-2.64), and low CD4+ count (p=0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR]=3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR=6.12; 95% CI: 1.90-19.73).

Conclusions: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.

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Conflict of interest statement

Conflicts of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Time to failure and recurrence among 61 HIV-infected women treated for CIN 1 who came for initial follow-up before (top group) or after (bottom group) 6 months.
Fig. 2
Fig. 2
Time to failure and recurrence 75 HIV-infected women treated for CIN 2+ who came for initial follow-up before (top group) or after (bottom group) 6 months.
See this image and copyright information in PMC

Comment in

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