OBJECTIVE: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infected women. METHODS: A retrospective cohort study was conducted in which 136 eligible HIV-infected women treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. RESULTS: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15-2.64), and low CD4+ count (p=0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR]=3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR=6.12; 95% CI: 1.90-19.73). CONCLUSIONS: Most CIN treatment of HIV-infected women studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infected women should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.
OBJECTIVE: To determine predictors of treatment failure and recurrence after surgical excisional procedures for CIN in HIV-infectedwomen. METHODS: A retrospective cohort study was conducted in which 136 eligible HIV-infectedwomen treated for CIN between 1999 and 2005 were included. Data were abstracted from charts and computer databases. Treatment failures were defined as the presence of CIN 1+ at initial follow-up. Recurrences were defined as the presence of CIN 1+ subsequent to initial normal follow-up. RESULTS: Treatment failure at initial follow-up was common, occurring in 51% of CIN 1 and 55% of CIN 2+. Most lesions detected at treatment failure were high grade (>70%), regardless of the grade of initial lesion. Significant risk factors for treatment failure were loop electrosurgical excision procedure (LEEP) compared to cold knife conization (RR=1.76; 95% CI: 1.15-2.64), and low CD4+ count (p=0.04). Among those with an initial normal clinical evaluation, 55% eventually recurred. As with treatment failure, most lesions detected at recurrence were high grade. Risk factors for recurrence included use of LEEP (hazard ratio [HR]=3.38; 95% CI: 1.55-7.39), higher HIV RNA level, and the presence of positive margins at treatment (HR=6.12; 95% CI: 1.90-19.73). CONCLUSIONS: Most CIN treatment of HIV-infectedwomen studied either failed or resulted in recurrence. Of particular concern, many of these subsequent lesions were high grade. Conization, however, was associated with significantly less failure/recurrence than LEEP. Clinicians treating CIN in HIV-infectedwomen should avoid raising expectations of cure and instead focus on the achievable goal of cancer prevention until there are better therapies for this patient population.
Authors: H Minkoff; L Ahdieh; L S Massad; K Anastos; D H Watts; S Melnick; L Muderspach; R Burk; J Palefsky Journal: AIDS Date: 2001-11-09 Impact factor: 4.177
Authors: T C Wright; J Koulos; F Schnoll; J Swanbeck; T V Ellerbrock; M A Chiasson; R M Richart Journal: Gynecol Oncol Date: 1994-11 Impact factor: 5.482
Authors: George K Siberry; Mark J Abzug; Sharon Nachman; Michael T Brady; Kenneth L Dominguez; Edward Handelsman; Lynne M Mofenson; Steve Nesheim Journal: Pediatr Infect Dis J Date: 2013-11 Impact factor: 2.129
Authors: Sharon A Greene; Hugo De Vuyst; Grace C John-Stewart; Barbra A Richardson; Christine J McGrath; Kara G Marson; T Tony Trinh; Nelly Yatich; Catherine Kiptinness; Anthony Cagle; Evans Nyongesa-Malava; Samah R Sakr; Nelly R Mugo; Michael H Chung Journal: JAMA Date: 2019-10-22 Impact factor: 56.272
Authors: Jessica A Kahn; Robert D Burk; Kathleen E Squires; Bill G Kapogiannis; Bret Rudy; Jiahong Xu; René Gonin; Nancy Liu; Carol Worrell; Craig M Wilson Journal: J Acquir Immune Defic Syndr Date: 2012-11-01 Impact factor: 3.731
Authors: Hilary K Whitham; Stephen E Hawes; Haitao Chu; J Michael Oakes; Alan R Lifson; Nancy B Kiviat; Papa Salif Sow; Geoffrey S Gottlieb; Selly Ba; Marie P Sy; Shalini L Kulasingam Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-05-17 Impact factor: 4.254
Authors: Scott Dryden-Peterson; Memory Bvochora-Nsingo; Gita Suneja; Jason A Efstathiou; Surbhi Grover; Sebathu Chiyapo; Doreen Ramogola-Masire; Malebogo Kebabonye-Pusoentsi; Rebecca Clayman; Abigail C Mapes; Neo Tapela; Aida Asmelash; Heluf Medhin; Akila N Viswanathan; Anthony H Russell; Lilie L Lin; Mukendi K A Kayembe; Mompati Mmalane; Thomas C Randall; Bruce Chabner; Shahin Lockman Journal: J Clin Oncol Date: 2016-11-01 Impact factor: 44.544
Authors: Jessica A Kahn; Jiahong Xu; Bill G Kapogiannis; Bret Rudy; René Gonin; Nancy Liu; Craig M Wilson; Carol Worrell; Kathleen E Squires Journal: Clin Infect Dis Date: 2013-05-10 Impact factor: 9.079
Authors: Hugo De Vuyst; Nelly R Mugo; Silvia Franceschi; Kevin McKenzie; Vanessa Tenet; Julia Njoroge; Farzana S Rana; Samah R Sakr; Peter J F Snijders; Michael H Chung Journal: PLoS One Date: 2014-10-24 Impact factor: 3.240