SEATTLEThe standard treatments for cervical squamous intraepithelial
lesions (SIL) are significantly less effective in HIV-infected women than in
HIV-uninfected women, according to the results of a study presented at the 9th
Conference on Retroviruses and Opportunistic Infections (abstract LB16).
"About half of HIV-infected women will develop cervical SIL. However,
little is known about the natural history of, or the best way to manage, SIL in
these women," said Thomas C. Wright, MD, associate professor of pathology,
The study included 122 HIV-infected women and 257 HIV-uninfected women with
Women with low-grade SIL were randomly assigned to observation or
cryotherapy. Women with high-grade SIL were randomly assigned to cryotherapy or
loop electrosurgical excision procedure (LEEP). Women with unsatisfactory
colposcopic examinations underwent cold-knife or LEEP conization.
Cervical cytology and/or histology was reassessed after a mean of 10 and 11
months in HIV-infected and HIV-uninfected women, respectively.
In women with low-grade SIL assigned to observation, the rate of spontaneous
regression to normal cervical cytology or histology was significantly lower in
HIV-infected women than in HIV-uninfected women (24% vs 61%), but the rate of
progression to biopsy-confirmed high-grade SIL did not differ significantly
between the two groups (4% vs 9%).
All three SIL treatment modalities were markedly less effective in the
HIV-infected women. In women with low-grade SIL who underwent cryotherapy, the
percentage of women with normal cervical cytology or histology at follow-up was
significantly lower in HIV-infected women than in HIV-uninfected women (56% vs