Common therapy for HIV associated with cervical abnormality regression

Among women infected with human immunodeficiency virus (HIV), a combination of antiretroviral drugs that helps boost the immune system is associated with the regression of a type of cervical abnormality that can eventually lead to cancer, according to a study in the July 21 issue of the Journal of the National Cancer Institute.

HIV infection is associated with an increased risk of abnormalities in the cervix called squamous intraepithelial lesions (SIL). In healthy women, the low-grade form of this type of abnormality often disappears on its own without treatment. Also, women who are HIV-positive are at an increased risk of infection with human papillomavirus (HPV), which are known to cause cervical cancer and its precursor lesions.

Highly active antiretroviral therapy (HAART) is a combination of several antiretroviral drugs that reduces the number of HIV particles in the bloodstream and helps boost immune system function. However, it is unclear whether the boost in immune status afforded by HAART improves the regression rates of SIL.

Linda Ahdieh-Grant, Ph.D., of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues analyzed data from the Women's Interagency HIV Study to examine the long-term effects of HAART on the regression of cervical SIL. Of the approximately 2,000 women who participated in the study, there were 312 women who had normal Pap smears at the time they entered the study and then, at some point during the 7 years of follow-up, were diagnosed with SIL.

The introduction of HAART was associated with a regression of SIL. Compared with women whose abnormality regressed, women whose lesions did not regress had more advanced HIV disease, including lower T-cell counts. Before women started HAART, the rate of disease regression was 0.0%; after HAART was introduced, the regression rate was 12.5%. However, the authors point out that the majority of the lesions in HIV-infected women, even among those who did use HAART, did not regress to normal.

"These findings underscore the importance of ensuring that women who are immunosuppressed have full access to antiretroviral therapy," the authors write. "It should be emphasized, however, that HIV-infected women on HAART must still receive careful gynecologic follow-up and close routine monitoring."

In an editorial, Long Fu Xi, M.D., Ph.D., and Nancy B. Kiviat, M.D., of the University of Washington in Seattle, further noted that the rates of regression in HIV-infected women receiving HAART remained lower than the rates seen in HIV-negative women or in HIV-infected women who never received HAART because they had less advanced HIV disease. "Thus, although the current study by the WIHS Group suggests that HAART likely affects regression of some low-grade cervical lesions, all HIV-positive women, including those on HAART, need to be encouraged to participate in cervical cancer screening programs," the editorialists write.

Contacts:

Article: Tim Parsons, Public Affairs, Johns Hopkins Bloomberg School of Public Health, 410-955-6878, paffairs@jhsph.edu

Editorial: Walter Neary, University of Washington, 206-685-1323, wneary@u.washington.edu

Citations:

Article: Ahdieh-Grant L, Li R, Levine AM, Massad LS, Strickler HD, Minkoff H, et al. Highly Active Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in Human Immunodeficiency Virus–Positive Women. J Natl Cancer Inst 2004;96:1070-6.

Editorial: Xi LF, Kiviat NB. Cervical Neoplasia and Highly Active Antiretroviral Therapy (HAART). J Natl Cancer Inst 2004;96:1051-3.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oupjournals.org/.

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Journal

JNCI Journal of the National Cancer Institute