OBJECTIVES: To assess whether adequate strategies are used for the management of cervical intraepithelial neoplasia (CIN) in HIV-positive patients. SETTING: Retrospective study in a HIV reference university hospital. Sixty-eight HIV-infected patients who had undergone a cervical biopsy between January 1995 and March 2002 were matched for CIN and age with HIV-negative patients. OUTCOME: Assess mean of treatment strategy. Assess mean of treatment failure by immediate follow-up PAP smear and recurrence rate by long-term follow-up smears. RESULTS: Both groups of patients received similar treatments for their cervical anomalies. HIV-positive women were two times more likely to have involved margins after conisation than HIV-negative women (P < 0.01). Globally, two thirds of HIV-negative patients had a first follow-up PAP smear that was normal, while this was the case in only one third of HIV-positive women. These proportions were also significantly different after conisation (P < 0.01). The same differences were also observed after sustained follow-up. HIV-infected women who showed a recurrence of dysplasia were more likely to have failed antiviral therapy (9/44) than those without any recurrence (7/12) (P < 0.01). CONCLUSIONS: Higher rates of recurrence were observed among HIV-infected women, indicating that CIN management is more difficult and may require adapted guidelines in HIV-positive patients. In HIV-infected patients, an association was found between the absence of recurrence and a viral response to antiviral therapy.
OBJECTIVES: To assess whether adequate strategies are used for the management of cervical intraepithelial neoplasia (CIN) in HIV-positivepatients. SETTING: Retrospective study in a HIV reference university hospital. Sixty-eight HIV-infectedpatients who had undergone a cervical biopsy between January 1995 and March 2002 were matched for CIN and age with HIV-negative patients. OUTCOME: Assess mean of treatment strategy. Assess mean of treatment failure by immediate follow-up PAP smear and recurrence rate by long-term follow-up smears. RESULTS: Both groups of patients received similar treatments for their cervical anomalies. HIV-positivewomen were two times more likely to have involved margins after conisation than HIV-negative women (P < 0.01). Globally, two thirds of HIV-negative patients had a first follow-up PAP smear that was normal, while this was the case in only one third of HIV-positivewomen. These proportions were also significantly different after conisation (P < 0.01). The same differences were also observed after sustained follow-up. HIV-infectedwomen who showed a recurrence of dysplasia were more likely to have failed antiviral therapy (9/44) than those without any recurrence (7/12) (P < 0.01). CONCLUSIONS: Higher rates of recurrence were observed among HIV-infectedwomen, indicating that CIN management is more difficult and may require adapted guidelines in HIV-positivepatients. In HIV-infectedpatients, an association was found between the absence of recurrence and a viral response to antiviral therapy.
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