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, Columbia University.
The study included 122 HIV-infected women and 257 HIV-uninfected women with biopsy-confirmed SIL.
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 95%).