is associated with a reduced incidence of pre-cancerous cervical lesions in
HIV-positive women, South African investigators report in the online edition
of AIDS. Their study also showed that
HIV therapy was associated with a regression of pre-existing lesions.
“Our results indicate
that compared to non-HAART [highly active antiretroviral therapy]-users,
HIV-infected women on HAART are more than twice as likely to exhibit regression
of cervical lesions,” write the authors. “HAART users with baseline normal
cervical smears are significantly less likely to suffer from incident
abnormalities in subsequent cervical smears.”
Cervical cancer has
been classified as an AIDS-defining illness since 1993. Most diagnoses involve
HIV-positive women in resource-limited settings, especially sub-Saharan Africa.
The malignancy is
caused by high-risk strains of human papillomavirus. This sexually transmitted
infection can cause pre-cancerous cell changes in the cervix and other
Incidence of the other
AIDS-defining cancers – non-Hodgkin’s lymphoma and Kaposi’s sarcoma – has
fallen significantly since the introduction of effective antiretroviral
therapy. This treatment has also been associated with the regression of disease
caused associated with these cancers.
However, the benefits
of HIV therapy regarding prevention of cervical cancer are less clear. To establish a clearer
understanding of its potential benefits, an international team of investigators
designed a study involving 1123 HIV-positive women in Soweto, South Africa, who
had at least two cervical smears between 2003 and 2009.
Their research had two
- To compare the incidence of abnormal cervical
smears in women with normal results at baseline according to the use or non-use
of HIV therapy.
- To assess the association between HIV treatment
and the regression/progression of cervical lesions.
The patients had a
mean baseline age of 33 years. Their mean body mass index (BMI) was 26.8.
Smoking – a risk factor for cervical cancer – was reported by 15% of women.
Symptoms of a sexually transmitted infection were detected in 18% of women when
they entered the study, at which time 75% of participants had a current sexual
Only 2% of individuals
were taking HIV therapy at baseline, a further 17% starting treatment during
The number of cervical
smears per patient ranged from two to seven with an average of three. The
median interval between consecutive smears varied from 181 to 2343 days, the
median interval being 421 days.
therapy reduced the risk of incident cervical lesions.
Women who had a normal
cervical smear at baseline were 38% less likely to develop an abnormality if
they were taking HIV therapy (p = 0.001).
A low CD4 cell count
was associated with an increased risk of developing abnormal cells. This was
irrespective of treatment with antiretroviral drugs. Incident lesions were
twice as likely to be detected in women with a CD4 cell count below 200
cells/mm3 compared to women with a CD4 cell count above 500 cells/mm3
(p = 0.001). Smoking was also associated with an increased risk of new cervical
disease (p = 0.05).
There was some
evidence that antiretroviral treatment was associated with a reduced risk of the
progression of cervical lesions. After taking into account other possible risk
factors, the investigators found that HIV therapy reduced the risk of
progression by 20%. However, this fell short of significance (95% CI, 0.56-1.13;
p = 0.20).
In contrast, HIV
treatment was associated with the regression of lesions. The odds of regression
were over twice as high for people taking antiretroviral therapy (OR =
2.61; 95% CI, 1.75-3.89; p < 0.001).
“We found that women
on HAART were more than twice as likely than non-HAART users to demonstrate
regression in consecutive smears,” conclude the authors. “In addition, we found
that among those women with a baseline normal smear, those on HAART were
significantly less likely to develop an abnormality in the future.”