To assess whether adequate strategies are used for the management of cervical intraepithelial neoplasia (CIN) in HIV-positive patients. Setting: Retrospectiv e study in a HIV reference university hospital. Sixty-eight HIV-infected patie nts 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 tr eatment strategy. Assess mean of treatment failure by immediate follow-up PAP s mear and recurrence rate by long-term follow-up smears. Both groups of patient s received similar treatments for their cervical anomalies. HIV-positive women were two times more likely to have involved margins after conisation than HIV-n egative women (P < 0.01). Globally, two thirds of HIV-negative patients had a f irst follow-up PAP smear that was normal, while this was the case in only one t hird of HIV-positive women. These proportions were also significantly different after conisation (P < 0.01). The same differences were also observed after sust ained 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 recur rence (7/12) (P < 0.01). Higher rates of recurrence were observed among HIV-inf ected women, indicating that CIN management is more difficult and may require ad apted guidelines in HIV-positive patients. In HIV-infected patients, an associ ation was found between the absence of recurrence and a viral response to antivi ral therapy.
展开▼
